Medication Drug Therapy Treatment For Raynaud Syndrome example essay topic

Treatment for Raynaud's - 2 - Introduction Raynaud syndrome is an auto-immune disorder in which blood vessels in the digits constrict. It usually strikes females between the ages of eighteen and thirty. "Between three to five percent of people are affected". (Harvard, 2003) There is no known cause or cure. (Segala et al, 2003) Clinical features primarily deal with (but are not limited to) the digits of the fingers. Other digits that may be affected include toes, nose, and ear lobes.

Exposure to cold and emotional stress triggers the vasoconstriction of the digits. It was originally described by the Catholic, French physician Maurice Raynaud in 1862. In this condition, the vaso spastic response is more frequently induced by exposure to cold temperatures and is often accompanied by digital color changes. After onset, a tri-color change [blanching (white), cyanosis (blue), and reactive hyperemia (red) ] occurs. "Pallor (blanching) shows vaso spasm and loss of arterial blood flow, cyanosis shows the de oxygenation of static venous blood, and rub or (red) shows reactive hyperemia following return of blood flow".

(Bowling, 2003) Theories for the causes of Raynaud syndrome include: arterial wall damage, connective tissue disease (CTD), or repetitive use of vibrational tools. (Ko, 2002) There are various methods of diagnosing Raydaund syndrome. Cold water emersion is one method. In this method, patients' hands are immersed in cold water to observe any clinical features.

Another mode of diagnosis looks at medical conditions that are associated with Raynaud syndrome, such as CTD, scleroderma, and lupus. A third technique includes physical examination of the ulnar and radial vessels, nail folds in the capillaries, presence of digital inflammation, (scleroderma, hardening of the skin, of the fingers and toes), or telangiectasis (chronic dilation of groups of capillaries Treatment for Raynaud's - 3 -that cause dark red blotches on the skin, usually on the face). Laboratory tests are another consideration of diagnosis. Tests consist of anti-nuclear anti-body (ANA) counts and anti- (an enzyme that reduces super-coiling in DNA by breaking and rejoining one or both strands of DNA).

High ANA's and low anti- are found in patients with Raynaud syndrome. (Desai, 2003) "Patients with circulating auto antibodies, antinuclear antibodies, and anti-Scl 70 antibodies are at (an) increased risk of developing a connective tissue disease. Systemic sclerosis is the connective tissue disease most frequently associated with Raynaud's phenomenon". (Bowling, 2003) This syndrome is described as primary Raynaud phenomenon (PRP) if is not associated with another disorder and as secondary Raynaud phenomenon (SRP) if it occurs in association with another disorder.

Statement of the Problem The episodes that occur due to Raynaud syndrome vary in duration. These episodes vary from a few minutes to a few hours depending on the duration of exposure to cold or the duration of exposure to emotional stress. Prolonged episodes lead to ulcerations of the digits. An ulceration is a section of the digit that has had prolonged cessation of blood flow due to extensive exposure to cold or emotional stress. The last stage of these attacks is when blood flow resumes.

This stage is always accompanied by pain. Raynaud syndrome is not a problem when kept under control. The problem arises when prolonged episodes occur. Prolonged exposure to cold leads to ulcerations of the digits.

Continual damage (ulcerations) of the same digit can then lead to amputation. Treatment for Raynaud's - 4 -The best solution is to keep all episodes under control through medication or to avoid situations in which cold temperatures or emotional stress is involved. Review of the Literature Introduction The purpose of the review of the related literature is to derive the best treatment for Raynaud syndrome. Much research has been collected on this topic.

The research collected discusses the following trends in the treatment of Raynaud syndrome: avoidance, medication, and natural supplements. Treatment: avoidance The best treatment for Raynaud phenomenon is avoidance of stimuli (prolonged exposure to cold or emotional stress). (Desai, 2003) When cold temperatures can not be avoided, mittens should be worn. Mittens trap warm air better than gloves do. Other conservative measures include layered clothing, heated socks, specially made gloves (electric, wool, cashmere, ceramic-impregnated), or occupational avoidance to vibration. Stimuli can also include smoking because smoking causes vasoconstriction, decreasing blood flow to the fingers and toes.

Therefore smoking should also be avoided. (Bowling 2003) These conservative measures work best on patients with PRP. In a study by Ko (2002), it was determined that ceramic-impregnated garments only showed slight improvement in patients with Raynaud syndrome. Ko ran a placebo-controlled experiment using ceramic-impregnated gloves. Patients were recruited through a newspaper ad in Canada. Respondents were then given a "Pal" questionnaire (see table 1).

This type of screening required a mandatory yes answer to question one Treatment for Raynaud's - 5 -and a total score greater than four. Nin tey-three people qualified for the study. They were then examined at Sunnybrook and the Canadian Centre for Integrative Medicine. Other conditions were also considered. The researchers looked at caffeine and alcohol consumption, use of birth control pills, and different medications taken. Half the participants were then supplied with ceramic-impregnated "thermo flow" gloves and the other half were supplied with placebo (cotton) gloves.

The look, feel, and smell of the gloves were similar. The study was conducted in two three-month segments. Tests used in the study were skin temperature measurements, Jamar grip strength, a hand dexterity test, and Phalen's sign (a wrist flexion test). Patients also kept a diary of Raynaud syndrome attacks.

Pre and post treatment evaluations were conducted. In the group given the ceramic-impregnated gloves, the test results indicated a slight decrease in the visual analogue scale (a measure of pain), a slight decrease in disability of the arm, shoulder and hand, a slight increase in finger temperature, as well as a slight increase in grip strength. The placebo group showed no major change in the tests administered. Ceramic impregnated gloves did prove to somewhat improve the condition. (Ko, 2002) Treatment for Raynaud's - 6 -Treatment: medication / drug therapy Treatment for Raynaud syndrome also includes drug therapy. Drug therapies are most successful when calcium channel blockers are used.

(Desai, 2003) There are many calcium channel blockers available in the United States. Some include Norvasc (generic name: ), Procardia (Nifedipine), Procardia XL (Nifedipine), Cardizem (Diltiazem), Dilator (Diltiazem), and Ada lat (Nifedipine). (Silverman et al, 1998) "These drugs block the passage of calcium, an essential factor in muscle contraction, into... (the smooth) muscle (of vessel walls). Such blockage interferes with the contraction of these muscles, which in turn dilates (widens) the veins and vessels that supply blood to them... Because arteries are dilated, they are less likely to spasm". (Silverman et al, 1998) Side effects of calcium channel blockers include headaches, nausea, dizziness, swelling, and feeling flushed.

These drugs are covered by most insurance companies and are therefore affordable. The annual cost is approximately $230. Vasodilators are another drug used to treat Raynaud syndrome, but they do not always produce complete relief and are therefore the second drug of choice. Other drug therapies for treatment include a nitric-oxide generating topical jelly and therapy (such as hypnosis). Treatment: natural supplements Natural supplements include vitamins and minerals known to improve circulation. One such supplement that is referred to as a cocktail due to the many supplements it contains is called Life Extension Mix.

This dietary supplement includes vitamin A, vitamin C, vitamin D, vitamin E, thiamine (vitamin B 1), riboflavin (vitamin B 2), niacin, Treatment for Raynaud's - 7 vitamin B 6, folic acid, vitamin B 12, biotin, acid, calcium, iodine, magnesium, zinc, selenium, copper, manganese, chromium, molybdenum, potassium, and many other supplements known to improve similar conditions in mice. (Life Extension, 2004) Vitamins A, C, E and selenium are called anti-oxidants and help protect cells from free radical damage. Free radicals are unstable oxygen molecules. "In... muscle cells, vitamin E protects fatty acids from free radicals' attacks". (Saltman et al, 1993) Vitamin D helps build bones and prevent osteoporosis. Since Raynaud syndrome targets women between the ages of eighteen and thirty, it is a good idea to supplement vitamin D. Thiamine helps convert carbohydrates and fats into energy.

Riboflavin helps "convert all bodily fuels to energy and maintain various tissues... They help release energy to cells, maintain the immune system, and form blood, nerve tissue, and collagen". (Saltman et al, 1993) Zinc helps maintain proper immune function. Since Raynaud syndrome is considered an autoimmune disorder, it is a good idea to supplement vitamins and minerals that aid in proper immune function. Niacin expands blood vessels which aids in circulation. A side effect of niacin is a flushed feeling.

Vitamin B 6 helps in the proper production of antibodies. Biotin, folic acid and vitamin B 12 help produce nucleic acids. Pantothenic acid aids in metabolic processes. Calcium helps build bone, prevent osteoporosis, and is essential to blood clotting.

Since niacin expands blood vessels to help circulation and therefore reduce vaso spasms, blood clotting agents are necessary if a cut occurs. Magnesium helps regulate heart function. Iodine facilitates the thyroid in regulating basal metabolism. Manganese aids in muscle function. Copper helps maintain the heart muscle and arteries. Lack of molybdenum can lead to rapid heart Treatment for Raynaud's - 8 -rhythms.

And potassium works with sodium to regulate blood pressure. (Saltman et al, 1993) The draw back to natural supplements is the cost. The dietary supplement, Life Extension Mix Caps, cost $82.80 per bottle. Each bottle contains four hundred and ninety capsules. The daily dosage is fourteen capsules. One bottle is a thirty-five day supply.

The annual cost would approximately be $2,484.10. This method of treatment can be costly because it is not covered by insurance companies. I chose this topic to inform the general public on Raynaud syndrome. This condition targets approximately five percent of our population and people should be Treatment for Raynaud's - 11 -aware of it. Chances are you know someone with the same symptoms. I believe much of my stress could have been alleviated if I had been properly informed.

Treatment for Raynaud's - 12 - Bibliographic Reference Bowling, J. (2003). Raynaud's disease. Lancet, 361 (9374), 2078-2081. Desai, R., & Korn, J. (2003).

Diagnosis and management of Raynaud phenomenon: presence of an underlying medical condition may warrant aggressive treatment. The Journal of Musculoskeletal Medicine, 20,124-131. Harvard. (2003). The big chill: raynaud's phenomenon.

Harvard Health Letter, 29 (1), 3. Ko, G.G., & Ber brayer, D. (2002). Effect of ceramic-impregnated "thermo flow" gloves on patient's with raynaud's syndrome: randomized, placebo-controlled study. Alternative Medicine Review, 7 (4), 328-336. Life Extension, (n. d. ). retrieved December 12, 2004, from Autoimmune Diseases: Online

Bibliography

for Health Concerns Web site: web P. (1993).
The University of California San Diego nutrition book. Boston: Little, Brown and Company. Segala, M. (2003).
Disease prevention and treatment. 4th ed. Hollywood, Fl: Life Extension Media. Silverman, H. (1998).