Raynaud's Phenomenon In Patients Research Articles

Possible Influence of Oxidative Stress on Development of Raynaud Phenomenon in Patients With CREST Scleroderma Syndrome

Abstract CREST syndrome represents a form of scleroderma where the progressive autoimmune reaction is mainly manifested by the main symptoms, which make this acronym: calcinosis cutis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly and teleangiectasia. Among the first affected organs is the skin followed by the excessive fibrosis manifested by the deposition of collagen in dermis. Reactive oxygen species (ROS) theory has been underlined as one of the main pathogenetic mechanisms and triggering factor in development of scleroderma. The present study was aimed at estimating the marker of lipid peroxidation products (MDA) in plasma of patients with CREST syndrome having manifested symptoms of both Raynaud syndrome and positive ANA antibodies. The lipid peroxidation (MDA) level was significantly higher in the patients who had CREST syndrome and Raynaud syndrome for less than 10 years compared to the patients suffering from Raynoud syndrome for more than 10 years (p<0.05). Both groups were found to have a significant MDA level increase (p<0.001) compared to the control healthy subjects. In conclusion, the relationship between lipid peroxidation (MDA level) and Raynaud syndrome appearance may emphasize the role of ROS produced by the ischemia-reperfusion injury as an early pathogenetic mechanism in CREST scleroderma syndrome.

Treatment of Raynaud phenomenon in systemic sclerosis

Systemic sclerosis is a connective tissue disease characterised by microvascular injury and excessive fibrosis of the skin and internal organs. Most patients with this condition experience Raynaud phenomenon, usually as the earliest manifestation of disease. In addition to pain and functional impairment, Raynaud phenomenon can produce tissue ischaemia resulting in digital ulceration and gangrene. Current treatments have been only moderately successful in reducing the frequency and severity of Raynaud phenomenon in patients with systemic sclerosis. This review will address treatments available for Raynaud phenomenon in systemic sclerosis.

Paradoxical Reaction of Raynaud Phenomenon following the Repeated Administration of Lloprost in a Patient with Diffuse Cutaneous Systemic Sclerosis

To report a paradoxical reaction of Raynaud phenomenon following the repeated administration of iloprost in a patient with diffuse cutaneous systemic sclerosis with vascular involvement. In January 2006, a 40-year-old male was diagnosed with diffuse cutaneous systemic sclerosis with pulmonary, esophageal, cutaneous, and vascular involvement (Raynaud phenomenon, with digital ulcers on his hands). In December 2008, treatment with iloprost was started due to worsening disease. Nine cycles of iloprost were administered at a rate of 0.5-1 ng/kg/min (6 hours per day, for 5 days every 6-8 weeks); the patient tolerated this treatment well. However, on the fourth day of cycles 10 and 11, the patient developed paradoxical Raynaud phenomenon in the hand with perfusion when the infusion was increased to 1 ng/kg/min, requiring treatment to be stopped. Treatment was continued during cycles 12 and 13 at 0.5 ng/kg/min; the patient tolerated the treatment well, although paradoxical Raynaud phenomenon occurred when the rate of infusion was increased. Raynaud phenomenon is extremely common in patients with scleroderma, and often is severe. Iloprost has vasodilating, antiplatelet, cytoprotective, and immunomodulating properties, and has been found to be an efficacious alternative to nifedipine for the treatment of Raynaud phenomenon in patients with scleroderma. The Naranjo probability scale indicated that iloprost was the probable cause of the paradoxical Raynaud phenomenon in this patient. This case demonstrates a probable relationship between the rate of infusion of iloprost and the paradoxical reaction of Raynaud phenomenon.

Elevated CSF levels of substance P and high incidence of Raynaud phenomenon in patients with fibromyalgia: new features for diagnosis

In 30 patients with diagnosed fibromyalgia, the CSF level of immunoreactive substance P (SP) was investigated. Compared to normal values (9.6 ± 3.2 fmol/ml), all the patients had elevated CSF levels of SP (36.1 ± 2.7 fmol/ml, range 16.5–79.1 fmol/ml). Anamnestic information from the patients revealed that 53.3% had Raynaud/Raynaud-like phenomenon localized in the fingers, the toes or both. Although SP levels did not differ significantly in patients with or without the Raynaud phenomenon, elevated activity may be present in the peripheral branches of SP neurons which could be responsible for the last (rubor) phase of the triphasic Raynaud's phenomenon. SP levels were significantly higher in patients who were smokers (40.1 ± 2.7 fmol/ml, range 25.3–64.1 fmol/ml), compared to patients who were non-smokers (29.2 ± 5.0 fmol/ml, range 16.5–79.1 fmol/ml). We propose elevated CSF levels of SP and the Raynaud phenomenon as characteristic features for fibromyalgia with potential as diagnostic markers of the disease and further that smoking might be an aggravating factor for its pathogenesis or development.