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Raynaud S Disease
 

Raynaud's disease Introduction

:raynauds-disease.jpg Raynaud’s disease is characterized by vasospasm of the small arteries in the fingers and toes. Areas such as the nose and tongue can also be affected. Raynaud’s disease (primary) can be initiated by cold, emotional stress, and occupational damage. The exact mechanism of injury is not fully understood in Raynaud’s disease.

Raynaud’s phenomenon (secondary) is characterized the same, but is the result of an underlying disease such as scleroderma, rheumatoid arthritis, and SLE. The vasospasm results in decreased blood flow, causing pallor and cyanosis. In severe cases of Raynaud’s phenomenon, necrosis can occur in the digits. Raynaud’s disease does not result in severe complications because the vasospasm ends when the stressor is removed. [1]

Researchers have failed to pinpoint the cause of Raynaud’s disease and several hypotheses exist regarding the disease’s origin. One of the most prominent hypotheses is that pro-inflammatory prostaglandins and leukotrienes damage the endothelial wall resulting in vasoconstriction. A defect in either nitric oxide synthesis, or metabolism is also thought to play a role in the development of Raynaud’s disease. Finally, damage to vessel integrity is thought to be mediated by free radicals and elevated homocysteine levels.

Raynaud’s disease affects women five times as often as men. The primary age of incidence is between 15 and 40 years old. Occupations such as pianists, typists, meat cutters, and chain saw users (vibratory tools) may be at a greater risk for developing Raynaud’s disease. Smokers are also at an increased risk for developing the condition. Precipitating factors to Raynaud’s disease may include external factors, such as cold weather and mental stress. [2]

Raynaud's disease Statistics

  • Raynaud’s affects 5-10% of the population.
  • One half of the cases are primary Raynaud’s disease, the other half being Raynaud’s phenomenon.
  • It is estimated that 13.6 million people in the US have Raynaud’s.
  • 75% of the cases are in women between the ages of 15 and 40 years old.
  • It is five times more common in women than men.
  • 20% of all young women are believed to have Raynaud’s disease.

Raynaud's disease Symptoms

The main symptom of Raynaud’s disease is color change in the digits. The skin may change color from white, to blue, and even red at times. There is often a numbness and tingling associated with the color change. There can be pain, but it is unusual. Warming the affected area usually relieve attacks associated with this condition, which may last from a few minutes to hours. There is no long-term damage as a result of these attacks in Raynaud’s disease. Although in Raynaud’s phenomenon the attacks may be long standing and necrosis of the digits can occur. [3]

Raynaud's disease Treatment

Conventional treatment of Raynaud’s disease begins by keeping the affected areas warm. Patients are instructed to stop smoking because of the vascoconstriction abilities of nicotine, which can exacerbate the condition. If necessary, pharmacologic drugs can be prescribed for vasodilation, including Prazosin, nifedipine, or pentoxyifyline. Treatment of Raynaud’s phenomenon is focused on the underlying disease.

Alternative treatment of Raynaud’s disease targets the underlying mechanisms. Research in this area has been quite promising and very practical; in comparison to using pharmaceutical drugs that treat only the symptoms, and not the cause.

Supplements helpful for Raynaud's disease

Arginine

Arginine is a pre-cursor to nitric oxide. Nitric oxide is a well-known vasodilator. A disruption in the synthesis and metabolism of nitric oxide is thought to play a role in the pathogenesis of Raynaud’s disease. Arginine supplementation produces vasodilation via the nitric oxide pathway. Several case reports using arginine show promising results for the treatment of Raynaud’s. Arginine was reported to reverse digital necrosis and improve symptoms in Raynaud’s sufferers. [4]

Inositol hexanicotinate (Vitamin B3)

Inositol hexanicotinate has vasodilatory properties. It has been studied as a treatment for Raynaud’s disease. In one study, B3 supplementation resulted in a decrease in the occurrence of attacks, as well as shorter duration of attacks. It also relieved symptoms significantly better than placebo. [5]

Vitamin C

Vitamin C is a potent anti-oxidant. It is an effective treatment option for individuals with Raynaud’s disease because of the proposed role of free radicals.

In one study of patients with Raynaud’s disease, Vitamin C was found to be deficient in a majority of individuals. This critical deficiency is thought to contribute to the severity of the disease. [6]

Fish oils

Fish oil is rich in essential fatty acids. These fatty acids are anti-inflammatory because they divert the prostaglandin synthesis away from pro-inflammatory molecules. Pro-inflammatory prostaglandins are thought to play a direct role in the pathogenesis of Raynaud’s disease. In one particular study, patients were given fish oil for 12 weeks. The supplementation group improved their cold tolerance and delayed onset of vasospasm, significantly over those receiving placebo. [7] These results were observed in individuals with Raynaud’s disease and not Raynaud’s phenomenon.

Evening Primrose oil

Evening primrose oil is also anti-inflammatory in nature. It effects are achieved in the same manner as fish oil, though the main essential fatty acid is DGLA. Numerous studies have been performed examining the efficacy of evening primrose oil in the treatment of Raynaud’s. In one study, its supplementation resulted in fewer attacks than placebo. These attacks were also rated as less severe, and there was an increase in cold tolerance. Most of the benefits were symptomatic; there was no observed measurable effect on blood flow. [8]

Vitamin B12, Vitamin B6, and Folic acid

Increased homocysteine is thought to play a role in the development of Raynaud’s disease. Homocysteine is a metabolite that can build up in the blood if Vitamin B12, B6, or folic acid is deficient. Homocysteine was measured in patients with Raynaud’s disease and was found to be elevated in both the primary and secondary classes of the disease. [9] Another study measured both homocysteine and folic acid levels in the blood of individuals with Raynaud’s and compared it to healthy controls. Homocysteine was elevated compared to controls and folic acid was decreased compared to controls. [10]

Ginkgo Biloba

Ginkgo biloba is a well-known botanical medicine. It is effective at increasing circulation and is an powerful anti-oxidant. In one study, ginkgo supplementation for 10 weeks reduced the number of attacks in patients with primary Raynaud’s disease. [11]

References

[1] Beers M and Berkow R. The Merck Manual 17th Ed. 1999. PP: 1790-1791.

[2] Fitzpatrick T et al. Color Atlas and Synopsis of Clinical Dermatology. 3rd Ed. 1997. McGraw-Hill New York. PP364-368.

[3] Beers M and Berkow R. The Merck Manual 17th Ed. 1999. PP: 1790-1791.

[4] Rembold CM and Ayers CR. Oral l-arginine can reverse digital necrosis in raynaud’s phenomenon. Mol Cell Biochem. 2003 Feb; 244(1-2): 139-141.

[5] Sunderland GT, Belch JJ, Sturrock RD, Forbes CD, and McKay AJ. A double blind randomized placebo-controlled trial of hexopal in primary raynaud’s disease. Clin Rheumatol. 1988 Mar; 7(1): 46-49.

[6] Herrick AL, Rieley F, Schofield D, Hollis S, Braganza JM, and Jayson MI. Micronutrient anti-oxidant status in patients with primary raynaud’s phenomenon and systemic sclerosis. J Rheumatol. 1994 Aug; 21(8): 1477-1483.

[7] Kremer JM and Shah DM. Fish oil dietary supplementation in patients with raynaud’s phenomenon: a double blind controlled prospective study. Am J Med. 1989 Feb; 86(2): 158-164.

[8] Belch JJ et al. Evening primrose oil (Efamol) in the treatment of raynaud’s phenomenon: a double blind study. Thromb Haemost. 1985 Aug; 30(54): 490-494.

[9] al-Awami M et al. Homocysteine levels in patients with raynaud’s phenomenon. Vasa. 2002 May; 31(2): 87-90.

[10] Levy Y et al. Elevated homocysteine levels in patients with raynaud’s syndrome. J Rheumatol. 1999 Nov; 26(11): 2383-2385.

[11] Muir AH, Robb R, McLaren M, Daly F, and Belch JJ. The use of ginkgo biloba in raynaud’s disease: a double blind placebo controlled trial. Vasc Med. 2002; 7(4): 265-267.