Idiopathic Raynaud's Disease Research Articles

The second thoracic sympathetic ganglion determines palm skin temperature in patients with essential palmar hyperhidrosis

Sympathectomy of the second (T2) and third (T3) thoracic ganglion is frequently performed for essential palmar hyperhidrosis and occasionally performed, in addition to stellectomy, for idiopathic Raynaud's disease. The increased palm skin temperature after the operation probably results from increased skin perfusion. To determine whether it was possible to limit the extent of sympathectomy for these patients, we recorded palm skin temperature after electric stimulation of stellate, T2 and T3 ganglia, and after randomized electrocautery of T2 and T3 ganglia in 20 patients. We analyzed the statistics according to paired t-test with Bonferroni adjustment. We found that palm skin temperature decreases significantly after stellate stimulation. While rising significantly after destruction of T2 ganglion in the presence of intact T3 ganglion ( P=0.00001), palm skin temperature did not rise significantly after T3 destruction in the presence of intact T2 ( P=0.779). Following T2 and T3 destruction, however, palm skin temperature rose despite stellate stimulation. This suggests that T2 ganglion determines palm skin temperature while stellate and other upper thoracic ganglia may play a minor role, that T2 sympathectomy suffices for the treatment of essential palmar hyperhidrosis, and that sympathectomy for Raynaud's disease might skip stellectomy.

Blockade of vasospastic attacks by alpha-2 adrenergic but not alpha-1 adrenergic antagonists in idiopathic Raynaud's disease: Freedman RR, Baer RP, Mayes MD. Circulation 92:1448, 1995

Blockade of vasospastic attacks by alpha-2 adrenergic but not alpha-1 adrenergic antagonists in idiopathic Raynaud's disease: Freedman RR, Baer RP, Mayes MD. Circulation 92:1448, 1995

Cold‐induced potentiation of α2‐adrenergic vasoconstriction in primary raynaud's disease

To determine the effects of local cooling on alpha-adrenergic responses in the fingers of patients with idiopathic Raynaud's disease. Clonidine HCl and phenylephrine HCl were administered through a brachial artery catheter while blood flow was measured by plethysmography in cooled and uncooled fingers. Cooling potentiated alpha 2-adrenergic vasoconstriction in the patients but depressed this response in the controls. Vasoconstrictive responses to phenylephrine were not significantly affected by cooling but were significantly greater in the patients than in the controls. Cold-induced sensitization of peripheral vascular alpha 2-adrenoceptors may be involved in the mechanism by which cooling triggers the vasospastic attacks of Raynaud's disease.

Plasma catecholamines during behavioral treatments for Raynaudʼs disease.

We have previously demonstrated that the vasospastic attacks of Raynaud's disease can be induced despite blockade of efferent digital nerves and that feedback-induced vasodilation is mediated through a non-neural, beta-adrenergic mechanism. Here, we sought to determine the role of sympathetic activity, as measured by plasma epinephrine and norepinephrine, during finger temperature feedback and autogenic training. Thirty-one female patients with idiopathic Raynaud's disease were randomly assigned to receive finger temperature feedback or autogenic training over 28 days. Half of each group began and finished training during the follicular phase of the menstrual cycle, the other half during the luteal phase. During training, significant temperature elevations were shown by feedback patients but not by autogenic patients. There were no significant effects for norepinephrine and epinephrine for either group. Cycle phase did not interact with training effects or with catecholamines. These findings do not support the role of decreased sympathetic activation in behavioral treatments for Raynaud's disease.

Transient Corneal Opacification Induced by Cold in Raynaud's Disease

AbstractA 48-year-old man presented with longstanding complaints of transient blurring of vision on exposure to cold temperatures. A review of family history was noteworthy in that two of the patient's four sons and the patients brother had similar complaints. All affected individuals had Raynaud's disease. Results of ophthalmic evaluation showed transient corneal opacities. Slit-lamp video photography under cold stress demonstrated conjunctival vascular changes consistent with Raynaud's phenomenon. An extensive work-up for systemic disease was otherwise negative. To the best of the authors' knowledge, anterior segment changes have not been described previously in idiopathic Raynaud's disease.

Temperature Biofeedback for Raynaud's Syndrome

To the Editor.— I read with interest your recent article entitled Behavioral Treatment of Raynaud's Syndrome 1 and thought that recent work on the treatment of idiopathic Raynaud's disease with biofeedback and the mechanisms of this treatment would be relevant. A controlled study comparing finger temperature feedback, finger temperature feedback under mild cold stress, autogenic relaxation, and electromyogram biofeedback found that the first two methods produced reported symptom reductions of 67% and 92%, respectively, at 1-year follow-up, whereas the latter two treatments were ineffective. 2 These results were corroborated by ambulatory recordings of finger and ambient temperatures and by laboratory tests of the ability to increase finger temperature voluntarily without feedback. Three-year follow-up data showed that the symptomatic improvement in the two temperature feedback groups was retained. 3 A series of subsequent studies 4 replicated the above findings and demonstrated that elevations in finger temperature were accompanied by increased finger

Increased α‐Adrenergic responsiveness in idiopathic raynaud's disease

In our study of 28 patients with idiopathic Raynaud's disease, the patients had significantly greater digital blood flow responses to intraarterial phenylephrine and clonidine than did normal control subjects. There were no group differences in finger blood flow responses to body heating, reflex cooling, digital ischemia, or to intraarterial tyramine or isoproterenol. There were also no group differences in blood pressure or heart rate during any procedure. These results suggest that patients with idiopathic Raynaud's disease have increased peripheral vascular alpha-adrenergic receptor sensitivity and/or density compared with normal persons.

Spinal cord stimulation for relief of chronic pain in vasospastic disorders of the upper limbs.

Eleven patients with chronic pain due to severe vasospastic disorders in the upper limbs were treated with cervical spinal cord stimulation. In 8 patients the pain was due to reflex sympathetic dystrophy in the late stage of the disease, and 3 patients had severe idiopathic Raynaud's disease. The mean follow-up for both groups was 27 months. A total of 10 patients (90.9%) had good or excellent results. Thermographic and plethysmographic changes were observed in both groups. There seems to be a very close relationship between the increase of blood flow and the amount of pain relief achieved. In an attempt to quantify the intensity of pain, the visual analog scale and McGill Pain Questionnaire were used. Stimulation proved to be harmless, with no mortality and very low morbidity. The latter centered around local infection and displacement of the electrodes. No objective changes occurred in trophic alterations such as bone decalcification and ankylosis, but there were improvements in the alterations in the nails and skin. In the reflex sympathetic dystrophy group, the amount of pain relief achieved enabled most patients to undergo subsequent physiotherapy and rehabilitation. In severe cases of reflex sympathetic dystrophy and idiopathic Raynaud's disease, spinal cord stimulation is an alternative treatment that can be used as primary therapy or as secondary therapy after unsuccessful sympathectomy or sympathetic blocks.

Effects of general and thematically relevant stressors in Raynaud's disease

Emotional Stress has been reported to cause vasospastic attacks in some patients with idiopathic Raynaud's disease. In the present study, the physiological and subjective responses of 32 Raynaud's disease patients and 22 normal subjects to three imagined scenes were compared. Both groups responded similarly to a neutral and a generally stressful scene. However, a scene having content thematically relevant to Raynaud's disease produced decreased finger temperature in these patients but not in normal controls. These findings are discussed in terms of stimulus specificity and social learning theories.

Effect of thromboxane synthetase inhibition in Raynaud's phenomenon.

To determine whether thromboxane A2 may be of pathogenetic importance in Raynaud's phenomenon, finger hemodynamic and clinical responses to dazoxiben, a thromboxane synthetase inhibitor, were studied in 25 subjects. Thirteen subjects had idiopathic Raynaud's disease and 12 subjects had secondary Raynaud's disease. A double-blind, 2-week crossover study design was used. Dazoxiben dose was 100 mg four times a day. Total fingertip blood flow (FBF) by venous occlusion plethysmography, fingertip capillary flow (FCF) by radioisotope disappearance rate, and finger systolic blood pressure (FSP) were measured in a 28.3 degree and a 20 degree room at the end of each period. Subjects kept diaries of vasospastic attacks. For the 25 subjects and the two subgroups, dazoxiben did not improve total FBF, FCF, or FSP. Subjects with idiopathic Raynaud's disease had a small decrease in the number of vasospastic attacks and an increase in percentage of attack-free days on dazoxiben, but in an overall evaluation by the subjects in both subgroups, dazoxiben did not improve symptoms. It is concluded that thromboxane is not of pathogenetic importance in Raynaud's phenomenon and that thromboxane synthesis inhibition is not of therapeutic benefit.

Biofeedback treatment for headaches, Raynaud's disease, essential hypertension, and irritable bowel syndrome: a review of the long-term follow-up literature.

Long-term follow-up evidence for biofeedback treatment of headaches, Raynaud's disease, essential hypertension, and the irritable bowel syndrome was reviewed. Acknowledging the difficulties with cross-study comparisons, the following general success rate were determined: primary idiopathic Raynaud's disease--70%, or better; vascular headache--70%, or better; mixed headache--about 60%; and muscle contraction headache--50%, or less. With relatively fewer patients, successful outcomes with the irritable bowel syndrome and secondary Raynaud's phenomenon were roughly 60% and 40%, respectively. Few cases of clinically significant long-term decreases in diastolic blood pressure were demonstrated; however, the need for medication was reduced or eliminated in some patients. There were indications that biofeedback combined with psychotherapy resulted in highest success rates. No differences were found in effectiveness between biofeedback, other relaxation techniques, and biofeedback in combination with relaxation techniques--all had essentially comparable rates of success. No correlations between physiological and psychological measures of condition at follow-up were reported. Implications and interpretations of these findings are discussed.

Induced vasodilation as treatment for Raynaud's disease.

We examined the efficacy of induced vasodilation as a treatment of idiopathic Raynaud's disease. Eight persons with Raynaud's disease and seven normal persons each received 27 simultaneous pairings of hand immersion in warm water (43 degrees C) for 10 minutes with exposure of the whole body to cold (0 degrees C). A second group of seven normal persons and nine persons with Raynaud's disease received no treatments. All subjects had cold test exposures (0 degrees C) at the start and end of the study. Subjects with Raynaud's disease who received treatments showed significant increases in digital temperatures (2.2 degrees C) during the cold test compared with the values of untreated subjects with Raynaud's disease (p less than 0.05); normal subjects who had received treatments showed no difference from those who had not. Digital temperatures of subjects with Raynaud's disease after treatment increased to levels approaching those of normal subjects, although they showed lower digital temperatures during initial exposure to cold (p less than 0.01). This therapy offers a practical alternative to traditional treatments.

Feedback and instructions in the control of digital skin temperature.

ABSTRACTFourteen female subjects suffering from idiopathic Raynaud's Disease were trained during 6 laboratory sessions to raise skin temperature. All subjects were given autogenic instructions and half the subjects were given skin temperature feedback from the middle digit of the dominant hand. Autogenic instructions were found to produce small but reliable increases in skin temperature regardless of whether or not feedback was provided. Following the autogenic instructions all subjects showed decreases in skin temperature. However, these decreases were greater for subjects not receiving feedback than for those receiving feedback. Theoretical implications of these data are discussed.

A 1-year follow-up of Raynaud's patients treated with behavioral therapy techniques.

The purpose of this study was to assess to what degree learned control of digital temperature and vasospastic attacks can be retained by Raynaud's patients over a full year period. Subjects were 19 patients suffering from diagnosed idiopathic Raynaud's disease who had undergone behavioral training. These patients had been trained to increase digital temperature using either autogenic training, biofeedback, or a combination of autogenic training and temperature biofeedback. Results indicated that the mean number of vasospastic attacks per day occurring 1 year after training was approximately equal to the number occurring at the end of the initial training (1.2-1.3 per day). Patient satisfaction with the treatment program was above average (3.5 on a 5-point scale). The patients' ability to maintain digital temperature during the cold stress challenge was imparied, however. At 1-year follow-up, digital temperature readings taken in the laboratory were identical to baseline levels.

Laterality of body focus and digital skin temperature in patients with Raynaud's disease.

ABSTRACTThe purpose of the present study was to assess the relationship between lateralization of body image and right versus left vasomotor activity. Fifteen right‐handed female patients suffering from idiopathic Raynaud's disease demonstrated a relationship between the extent of right lateralization of body image and bilateral digital skin temperature during a controlled temperature stress test. In addition, subjects showing a reliable right side awareness demonstrated more unilateral vasospastic attacks in their right hand than their left hand white subjects showing no clear right lateralization by body image reported more left hand attacks than right hand attacks. These results were taken as consistent with previous work on the relationship between skin conductance and lateralization of body image.