Raynaud’s disease

Raynaud’s disease

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  RAYNAUD’S DISEASE PRESENTED BY R.PRIYA
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  INTRODUCTION RAYNAUD'S DISEASE ISA RARE DISORDER OF THE BLOOD VESSELS, USUALLY IN THE FINGERS AND TOES. IT CAUSES THE BLOOD VESSELS TO NARROW WHEN YOU ARE COLD OR FEELING STRESSED. WHEN THIS HAPPENS, BLOOD CAN'T GET TO THE SURFACE OF THE SKIN AND THE AFFECTED AREAS TURN WHITE AND BLUE. RAYNAUD'S DISEASE IS A RARE DISORDER OF THE BLOOD VESSELS, USUALLY IN THE FINGERS AND TOES. IT CAUSES THE BLOOD VESSELS TO NARROW WHEN YOU ARE COLD OR FEELING STRESSED. WHEN THIS HAPPENS, BLOOD CAN'T GET TO THE SURFACE OF THE SKIN AND THE AFFECTED AREAS TURN WHITE AND BLUE. WHEN THE BLOOD FLOW RETURNS, THE SKIN TURNS RED AND THROBS OR TINGLES. IN SEVERE CASES, LOSS OF BLOOD FLOW CAN CAUSE SORES OR TISSUE DEATH.
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  DEFINITION RAYNAUD’S DISEASE ISWHENBLOODVESSELS INYOUR FINGERSANDTOESTEMPORARILY OVERREACT TO LOWTEMPERATURES OR STRESS. FOR MOST PEOPLE, IT ISN’T A SERIOUS HEALTH PROBLEM. BUT FOR SOME,THE REDUCED BLOOD FLOW CAN CAUSE DAMAGE.
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  TYPES • PRIMARY RAYNAUD'S.THEY OCCUR BY THEMSELVES AND NOT IN ASSOCIATION WITH OTHER DISEASES. SYMPTOMS ARE IDIOPATHIC, PARTLY HEREDITARY. SMOKING THIS MOST COMMON FORM ISN'T THE RESULT OF AN ASSOCIATED MEDICAL CONDITION. IT CAN BE SO MILD THAT MANY PEOPLE WITH PRIMARY RAYNAUD'S DON'T SEEK TREATMENT. AND IT CAN RESOLVE ON ITS OWN. •SECONDARY RAYNAUD'S. ALSO CALLED RAYNAUD'S PHENOMENON, THIS FORM IS CAUSED BY AN UNDERLYING PROBLEM. ALTHOUGH SECONDARY RAYNAUD'S IS LESS COMMON THAN THE PRIMARY FORM, IT TENDS TO BE MORE SERIOUS. RAYNAUD'S PHENOMENON, OR SECONDARY RAYNAUD'S, OCCURS SECONDARY TO A WIDE VARIETY OF OTHER CONDITIONS. SECONDARY RAYNAUD'S HAS A NUMBER OF ASSOCIATIONS: •CONNECTIVE TISSUE DISORDERS: • Scleroderma • Systemic lupus erythematosus • Rheumatoid arthritis •EATING DISORDERS: • Anorexia nervosa •OBSTRUCTIVE DISORDERS: • Atherosclerosis • Buerger's disease • Takayasu's arteritis
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  TYPES • Drugs:Beta-blockers • Cytotoxicdrugs – particularly chemotherapeutics and most especially bleomycin • Cyclosporin • Bromocriptine • Occupation: • Jobs involving vibration, particularly drilling and prolonged use of a string trimmer (weed whacker), suffer from vibration white finger • Exposure to vinyl chloride, mercury • Exposure to the cold (e.g., by working as a frozen food packer)
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  TYPES  PRIMARY RAYNAUD'S.THEY OCCUR BY THEMSELVES AND NOT IN ASSOCIATION WITH OTHER DISEASES. SYMPTOMS ARE IDIOPATHIC, PARTLY HEREDITARY. SMOKING • THIS MOST COMMON FORM ISN'T THE RESULT OF AN ASSOCIATED MEDICAL CONDITION. IT CAN BE SO MILD THAT MANY PEOPLE WITH PRIMARY RAYNAUD'S DON'T SEEK TREATMENT. AND IT CAN RESOLVE ON ITS OWN. •SECONDARY RAYNAUD'S. ALSO CALLED RAYNAUD'S PHENOMENON, THIS FORM IS CAUSED BY AN UNDERLYING PROBLEM. ALTHOUGH SECONDARY RAYNAUD'S IS LESS COMMON THAN THE PRIMARY FORM, IT TENDS TO BE MORE SERIOUS.  SECONDARY  RAYNAUD'S PHENOMENON, OR SECONDARY RAYNAUD'S, OCCURS SECONDARY TO A WIDE VARIETY OF OTHER CONDITIONS. SECONDARY RAYNAUD'S HAS A NUMBER OF ASSOCIATIONS •CONNECTIVE TISSUE DISORDERS: • Scleroderma • Systemic lupus erythematosus • Rheumatoid arthritis •EATING DISORDERS: • Anorexia nervosa •OBSTRUCTIVE DISORDERS: • Atherosclerosis • Buerger's disease • Takayasu's arteritis
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  RISK FACTOR RISK FACTORSFOR PRIMARY RAYNAUD'S INCLUDE SO MANY AS ONE IN 10 PEOPLE MAY HAVE SOME FORM OF RAYNAUD’S. MOST HAVE PRIMARY RAYNAUD’S.ABOUT ONE PERSON IN 100, OR FEWER,WILL HAVE SECONDARY RAYNAUD’S. •SEX. MORE WOMEN THAN MEN ARE AFFECTED.WOMEN ARE UPTO NINETIMES MORE LIKELYTO GET ITTHAN MEN. •AGE. ALTHOUGH ANYONE CAN DEVELOP THE CONDITION, PRIMARY RAYNAUD'S OFTEN BEGINS BETWEEN THE AGES OF 15 AND 30. •CLIMATE. THE DISORDER IS ALSO MORE COMMON IN PEOPLE WHO LIVE IN COLDER CLIMATES. •FAMILY HISTORY. A FIRST-DEGREE RELATIVE — A PARENT, SIBLING OR CHILD — HAVING THE DISEASE APPEARS TO INCREASE YOUR RISK OF PRIMARY RAYNAUD'S. RISK FACTORS FOR SECONDARY RAYNAUD'S INCLUDE: •ASSOCIATED DISEASES. THESE INCLUDE CONDITIONS SUCH AS SCLERODERMAAND LUPUS. •CERTAIN OCCUPATIONS. THESE INCLUDE JOBS THAT CAUSE REPETITIVE TRAUMA, SUCH AS OPERATING TOOLS THAT VIBRATE. •EXPOSURE TO CERTAIN SUBSTANCES. THIS INCLUDES SMOKING, TAKING MEDICATIONS THAT AFFECT THE BLOOD VESSELS AND BEING EXPOSED TO CERTAIN CHEMICALS, SUCH AS VINYL CHLORIDE.
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  RISK FACTOR •WOMEN AREUPTO NINETIMES MORE LIKELYTO GET ITTHAN MEN. •PEOPLEOF ALL AGESCAN GET PRIMARY RAYNAUD’S, BUT IT USUALLY SHOWS UP BETWEENAGES 15 AND 25. •PEOPLEWITH SECONDARY RAYNAUD’STENDTO GET IT AFTER 35. •PEOPLEWITH ILLNESSES LIKE RHEUMATOIDARTHRITIS, SCLERODERMA,AND LUPUS ARE MORE LIKELYTO GET SECONDARY RAYNAUD’S. •PEOPLEWHO USE SOME MEDICINESTOTREAT CANCER, MIGRAINES,OR HIGH BLOOD PRESSURE MAY BE MORE LIKELYTO GET RAYNAUD’S. •ALSO, PEOPLEWHO HAVE CARPALTUNNEL SYNDROMEOR USEVIBRATINGTOOLS LIKE JACKHAMMERS MAY BE MORE LIKELYTO GET RAYNAUD’S.
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  PATHOPHYSIOLOGY
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  SIGNS AND SYMPTOMS SIGNSAND SYMPTOMS OF RAYNAUD'S DISEASE INCLUDE: •COLD FINGERS OR TOES •COLOR CHANGES IN YOUR SKIN IN RESPONSE TO COLD OR STRESS •NUMB, PRICKLY FEELING OR STINGING PAIN UPON WARMING OR STRESS RELIEF
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  DIAGNOSTIC EVALUATION •DIGITAL ARTERYPRESSURES ARE MEASURED IN THE ARTERIES OF THE FINGERS BEFORE AND AFTER THE HANDS HAVE BEEN COOLED. A DECREASE OF AT LEAST 15 MMHG IS DIAGNOSTIC (POSITIVE). •DOPPLER ULTRASOUND TO ASSESS BLOOD FLOW •FULL BLOOD COUNT MAY REVEAL A NORMOCYTIC ANAEMIA SUGGESTING THE ANAEMIA OF CHRONIC DISEASE OR KIDNEY FAILURE. •BLOOD TEST FOR UREA AND ELECTROLYTES MAY REVEAL KIDNEY IMPAIRMENT. •THYROID FUNCTION TESTS MAY REVEAL HYPOTHYROIDISM. •TESTS FOR RHEUMATOID FACTOR, ERYTHROCYTE SEDIMENTATION RATE, C-REACTIVE PROTEIN, AND AUTOANTIBODY SCREENING MAY REVEAL SPECIFIC CAUSATIVE ILLNESSES OR AN INFLAMMATORY PROCESS. ANTI-CENTROMERE ANTIBODIES ARE COMMON IN LIMITED SYSTEMIC SCLEROSIS (CREST SYNDROME). •NAIL FOLD VASCULATURE (CAPILLAROSCOPY) CAN BE EXAMINED UNDER A MICROSCOPE.
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  DIAGNOSTIC EVALUATION MEDICATIONS CANBE HELPFUL FOR MODERATE OR SEVERE DISEASE. •VASODILATORS – CALCIUM CHANNEL BLOCKERS, SUCH AS THE DIHYDROPYRIDINES NIFEDIPINE OR AMLODIPINE, PREFERABLY SLOW-RELEASE PREPARATIONS – ARE OFTEN FIRST-LINE TREATMENT. THEY HAVE THE COMMON SIDE EFFECTS OF HEADACHE, FLUSHING, AND ANKLE EDEMA, BUT THESE ARE NOT TYPICALLY OF SUFFICIENT SEVERITY TO REQUIRE CESSATION OF TREATMENT . THE LIMITED EVIDENCE AVAILABLE SHOWS THAT CALCIUM-CHANNEL BLOCKERS ARE ONLY SLIGHTLY EFFECTIVE IN REDUCING HOW OFTEN THE ATTACKS HAPPEN.[24] ALTHOUGH, OTHER STUDIES ALSO REVEAL THAT CCBS MAY BE EFFECTIVE AT DECREASING SEVERITY OF ATTACKS, PAIN AND DISABILITY ASSOCIATED WITH RAYNAUD'S PHENOMENON. PEOPLE WHOSE DISEASE IS SECONDARY TO ERYTHROMELALGIA OFTEN CANNOT USE VASODILATORS FOR THERAPY, AS THEY TRIGGER 'FLARES' CAUSING THE EXTREMITIES TO BECOME BURNING RED DUE TO TOO MUCH BLOOD SUPPLY. •PEOPLE WITH SEVERE DISEASE PRONE TO ULCERATION OR LARGE ARTERY THROMBOTIC EVENTS MAY BE PRESCRIBED ASPIRIN. •SYMPATHOLYTIC AGENTS, SUCH AS THE ALPHA-ADRENERGIC BLOCKER PRAZOSIN, MAY PROVIDE TEMPORARY RELIEF TO SECONDARY RAYNAUD'S PHENOMENON. •LOSARTAN CAN, AND TOPICAL NITRATES MAY, REDUCE THE SEVERITY AND FREQUENCY OF ATTACKS, AND THE PHOSPHODIESTERASE INHIBITORS SILDENAFIL AND TADALAFIL MAY REDUCE THEIR SEVERITY.
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  MANAGEMENT •Angiotensin receptor blockersor ACE inhibitors may aid blood flow to the fingers, and some evidence shows that angiotensin receptor blockers (often losartan) reduce frequency and severity of attacks , and possibly better than nifedipine.[28][29] •The prostaglandin iloprost is used to manage critical ischemia and pulmonary hypertension in Raynaud's phenomenon, and the endothelin receptor antagonist bosentan is used to manage severe pulmonary hypertension and prevent finger ulcers in scleroderma. •Statins have a protective effect on blood vessels, and SSRIs such as fluoxetine may help symptoms, but the data is weak • PDE inhibitors are used off-label to treat severe ischemia and ulcers in fingers and toes for people with secondary Raynaud's phenomenon; as of 2016, their role more generally in Raynaud's was not clear.
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  SURGICAL MANAGEMENT • Insevere cases, an endoscopic thoracic sympathectomy procedure • can be performedsurgically cut. Microvascular surgery of the affected areas is another possible therapy, but this procedure should be considered as a last resort.
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  PREVENTION •BUNDLE UP OUTDOORS.WHEN IT'S COLD, DON A HAT, SCARF, SOCKS AND BOOTS, AND TWO LAYERS OF MITTENS OR GLOVES BEFORE YOU GO OUTSIDE. WEAR A COAT WITH SNUG CUFFS TO GO AROUND YOUR MITTENS OR GLOVES, TO PREVENT COLD AIR FROM REACHING YOUR HANDS. •ALSO USE CHEMICAL HAND WARMERS. WEAR EARMUFFS AND A FACE MASK IF THE TIP OF YOUR NOSE AND YOUR EARLOBES ARE SENSITIVE TO COLD. •WARM YOUR CAR. RUN YOUR CAR HEATER FOR A FEW MINUTES BEFORE DRIVING IN COLD WEATHER. •TAKE PRECAUTIONS INDOORS. WEAR SOCKS. WHEN TAKING FOOD OUT OF THE REFRIGERATOR OR FREEZER, WEAR GLOVES, MITTENS OR OVEN MITTS. SOME PEOPLE FIND IT HELPFUL TO WEAR MITTENS AND SOCKS TO BED DURING WINTER. •BECAUSE AIR CONDITIONING CAN TRIGGER ATTACKS, SET YOUR AIR CONDITIONER TO A WARMER TEMPERATURE. USE INSULATED DRINKING GLASSES.
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  HOME TREATMENT HOME TREATMENTFOR RAYNAUD’S THESE STEPS CAN ALSO HELP YOU CONTROL YOUR CONDITION: •AVOID SMOKE: DON’T SMOKE, AND STAY AWAY FROM SECONDHAND SMOKE, TOO. IT CAN MAKE YOUR BLOOD VESSELS CLOSE UP, WHICH LOWERS YOUR SKIN TEMPERATURE. •EXERCISE: IT’LL BOOST YOUR CIRCULATION. IF YOU HAVE SECONDARY RAYNAUD’S, CHECK WITH YOUR DOCTOR BEFORE YOU TRY AN OUTDOORS WORKOUT IN COLD WEATHER. •MANAGE STRESS: KEEPING IT UNDER CONTROL COULD HELP CUT THE NUMBER OF ATTACKS. •KEEP YOUR TEMPERATURE CONSTANT: DON’T GO STRAIGHT FROM A CHILLY SPACE TO A WARM SPACE IF YOU CAN HELP IT. AVOID THE FROZEN-FOOD SECTION OF THE GROCERY STORE AS MUCH •DRESS FOR THE COLD: WEAR LAYERS, GLOVES, AND HEAVY SOCKS. BUY CHEMICAL WARMERS FOR YOUR POCKETS, GLOVES, AND SOCKS. •AVOID SOME MEDICATIONS :DECONGESTANTS WITH PHENYLEPHRINE, DIET PILLS, MIGRAINE MEDICATIONS WITH ERGOTAMINE, HERBAL MEDICATIONS WITH EPHEDRA, AND THE BLOOD MEDICATION CLONIDINE (CATAPRES) CAN ALL NARROW YOUR BLOOD VESSELS. •SOAK YOUR HANDS: OR RUN WARM WATER OVER THEM WHEN YOU FEEL AN ATTACK STARTING.
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  THANK YOU