Patient Information - Raynauds, Scleroderma & Associated
Disorders
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1. What is Raynaud's?
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| Raynaud's is a condition where the blood supply to
the extremities, usually the fingers and toes, but occasionally the
nose or ears, is interrupted. During an attack the affected part
first becomes white and dead looking, then turns blue as
the tissues use up the oxygen and finally bright red as the
arteries relax and fresh blood rushes in. Primary Raynaud's
can vary from a very mild form, being little more than a
nuisance, to a severe form requiring treatment. Anyone of
any age can suffer from Raynaud's, but teenage women are
affected more commonly. This may decline in severity after
the menopause. It seems to be a change in temperature, rather
than just cold exposure that precipitates an attack, so
although worse in winter, it can occur in summer. Stress or
anxiety can also provoke a Raynaud's attack. Secondary
Raynaud's is associated with some other disease or external influence. |
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2. What is Scleroderma?
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| The word scleroderma means hardening of the skin.
It is a disease of the connective tissue, which as the name implies
holds our bodies together. Therefore not only the skin can be
affected, but also internal organs. The majority of
sufferers have the mild form where there is limited skin
involvement, usually of the hands and feet, becoming stiff
and shiny. The gullet often becomes affected making eating and
swallowing difficult. Some patients also form tiny deposits
of calcium under the skin (calcinosis) which can cause
ulceration. In the more severe form, called diffuse
scleroderma, wide areas of skin and internal organs such as the
lungs, bowel heart and kidneys are affected. Localised
scleroderma can be divided into two types: Morphea and linear
scleroderma. Morphea is the name given to localised patches
of hardening of the skin. Linear scleroderma develops in
childhood and may affect the growth of a limb, and is
usually limited to one area. Unlike morphea, linear scleroderma
tends to involve deeper layers and can affect the mobility
of underlying joints. |
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3. How are they diagnosed?
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| The history of the disease is most important.
Blood tests may help, as can examining the small blood vessels
at the base of the nail, nail fold capillaroscopy. |
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4. Is it hereditary?
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| There is no evidence at present that either
Raynaud's or scleroderma are directly inherited. There is
however a genetic predisposition, so that the chances of
being affected are greater if a relative has the problem. |
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5. How can I help myself?
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There are several things you can do which may
help. The most important is to stop smoking, take regular exercise
and keep warm.
Smoking. If you are a smoker you
must make a sincere and determined effort to give up completely.
Tobacco is harmful as it causes the blood vessels to
constrict, decreasing the blood flow to the finger tips. The
best way to give up is to choose a day when you are going
to stop completely rather than trying to cut down gradually. If
you do have trouble giving up please ask your doctor who
can put you in touch with a support group.
Eating for warmth. Eating and
drinking can help you keep warm. Try to eat lots of small meals
to maintain your energy, high protein foods, milk, meat,
fish, and fresh vegetables are best. Hot meals and plenty of hot
drinks, especially before retiring are essential.
Exercise. Gentle exercise will help
your circulation. Try to avoid sitting for long periods. Get up
and walk around the room, moving arms and legs to maintain
the circulation. Do not however let your fingers or toes get cold.
In cold weather take exercise indoors.
Clothing. Tight clothing should be
avoided as this may restrict blood flow. Hands and feet should
always be adequately covered. A scarf should be used to
keep the face warm in cold weather and a hat and several layers
of clothing should be used to keep the head and trunk warm.
Feet are especially prone to cooling, therefore a good thick
pair of socks is essential. Wet shoes and clothes should be
changed as soon as possible.
(More details can be
obtained from: The Raynaud's Association, 112 Crewe Rd., Alsager,
Cheshire ST7 2JA. Tel 01270-872776.)
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6. What about treatment?
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| Your GP or specialist may prescribe a vasodilator,
which is a drug that relaxes the blood vessels. Occasionally, your
specialist may feel an operation called a sympathectomy, may be
of benefit. This involves either cutting or destroying the
nerves that cause the arteries to constrict. This operation is
more successful for Raynaud's of the feet, your specialist
will explain this to you. |
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7. Associated conditions
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Vibration White Finger.
Those who work with vibrating tools have a tendency to develop
Raynaud's especially if the vibration is coarse and of low
frequency. This can become permanent even after the work has
stopped. VWF is an industrial disease which may be eligible
for compensation.
Chilblains. These usually
appear on the extremities-fingers, toes, and ears. The skin may
first become itchy, the red, swollen and very tender to
touch. Chilblains occur as a result of defective circulation on
exposure to cold. Clothing that rubs should be avoided.
Rheumatoid Arthritis.
Arthritis affects the lining of the joints. This lining produces
a fluid that lubricates the joint and when affected by
rheumatoid arthritis it becomes inflamed and swollen. More fluid
is produced causing a red, painful swollen joint. About 10%
of rheumatoid arthritis sufferers have Secondary Raynaud's.
Systemic Lupus Erythematosis.
This is characterised by a rash sometimes seen on both cheeks
and the bridge of the nose, and chronic inflammation of the
blood vessels and connective tissues of the body. There is associated
tiredness, joint pain, mouth ulcers, hair loss and Raynaud's.
Erythromyalgia. This is a
chronic disorder characterised by persistent warmth, pain and
redness, mainly affecting the feet and lower legs. The
majority of sufferers also experience Raynaud's symptoms.
Chemical or drug induced.
Some chemicals at work (vinyl chloride) or drugs such as Beta
Blockers, migraine tablets or the oral contraceptive may
aggravate Raynaud's, therefore, if you are prescribed any
medicines and you experience Raynaud's type symptoms, check
with your GP. who may be able to alter your medication. |
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8. What is the prognosis?
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| People who develop Raynaud's as teenagers often
have a form that is benign and will disappear with age. Unfortunately
this is not true in all cases, and sometimes Raynaud's does
persist. There is no cure for scleroderma at present but
there are many effective treatments available to alleviate
specific symptoms. |
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