Do you know? When I open the door, my hands change color when they are cold. Am I sick?

Contributor: Cong Shan, attending physician of the Department of Rheumatology and Immunology, the First Affiliated Hospital of Xinjiang Medical University;

Review expert: Luo Li, chairman of the Clinical Immunology Branch of the Xinjiang Immunology Society; vice president of the Xinjiang Uygur Autonomous Region Immunology Society; director, professor and chief physician of the Department of Rheumatology and Immunology, the First Affiliated Hospital of Xinjiang Medical University.

The weather has been getting colder recently, with the lowest temperature in some parts of northern Xinjiang reaching below -20℃. Some people have found that their hands have turned pale, purple or black after being exposed to cold air or water. Some have also experienced stiffness, pain, ulceration of the fingertips and other discomforts, which are particularly severe in winter. What is going on?

When encountering this situation, we should be alert to a pathological phenomenon - Raynaud's phenomenon. Raynaud's phenomenon is a series of characteristic changes that occur when the human body is exposed to cold or mental stress: the skin of the fingers becomes pale, cyanotic, then flushed, and finally returns to normal, sometimes accompanied by brief pain. The color change may be triphasic (pale, followed by cyanosis and erythema caused by reactive hyperemia after warmth), biphasic (cyanosis, erythema), or monophasic (only pale or cyanosis). In 1862, French doctor Raynaud first reported this type of disease, so it was named "Raynaud's". Raynaud's phenomenon can also occur in the tip of the nose, auricle, toes and other locations. This change is mainly due to spasm of terminal small blood vessels and stenosis of the lumen, resulting in local transient ischemia. Raynaud's phenomenon is divided into primary and secondary types. Secondary Raynaud's phenomenon can be seen in rheumatic and immune diseases, obstructive arterial disease, primary pulmonary hypertension, trauma, nervous system diseases, blood diseases, drugs and poisons, etc. Among them, Raynaud's phenomenon is more common in rheumatic and immune diseases.

Which rheumatic autoimmune diseases may cause Raynaud's phenomenon?

●Raynaud's phenomenon is one of the manifestations that can occur in many rheumatic and immune diseases, and it is also a common first manifestation. It is mainly because the disease affects small blood vessels, which are very sensitive when encountering cold stimulation, resulting in the inability of blood vessels to dilate normally. Raynaud's phenomenon can be secondary to systemic sclerosis (the most common), rheumatoid arthritis, systemic lupus erythematosus, mixed connective tissue disease, dermatomyositis, polymyositis, vasculitis, etc. If you find that your Raynaud's phenomenon occurs frequently and there are obvious symptoms such as hair loss, joint swelling and pain, photosensitivity, rash, fingertip ulceration, poor or thickened skin elasticity, and asthma, you should immediately go to a rheumatology and immunology specialist for treatment. At the same time, you should complete tests such as autoantibodies, erythrocyte sedimentation rate, C-reactive protein, complement testing, etc. to clarify the condition and conduct a systematic organ evaluation.

What should I do if I find myself having Renault symptoms?

●First, it is recommended that patients visit a rheumatologist to identify the cause. If it is secondary Raynaud's phenomenon, a comprehensive assessment of the condition is required, starting from the cause, actively treating the primary disease, formulating a treatment plan, and long-term follow-up treatment.

●The main triggering factor of Raynaud's phenomenon is cold stimulation, so keeping warm is the most important thing in daily care. Patients are advised to keep warm when the weather is cold, wear gloves, earmuffs, and hats. If ordinary gloves are difficult to maintain a constant temperature, you can buy heating gloves, but you need to pay attention to the temperature to avoid burns.

●Smoking is one of the risk factors for Raynaud's phenomenon. It is recommended to quit smoking.

●Mental factors can also lead to the recurrence of Raynaud's phenomenon. You should pay attention to your daily routine, maintain a stable mood, avoid mental stress and excessive fatigue. Appropriate exercise can promote blood circulation throughout the body and relieve the occurrence of negative emotions.

●Raynaud's phenomenon will affect the blood circulation of the extremities and the repair ability of the fingertips after injury, so the fingers should be protected from chemical, physical and mechanical damage. Patients who like to soak their feet should pay attention to the water temperature to avoid burns due to lack of sensitivity to temperature.

●Avoid taking medications that cause vasoconstriction, such as beta-blockers and birth control pills.

● Treatment of secondary Raynaud's phenomenon focuses on the underlying disease. Topical nitroglycerin patches, calcium channel blockers, or prazosin can be used under the guidance of a doctor. If accompanied by local ischemic necrosis, antibiotics, analgesics, and occasionally surgical resection of necrotic tissue from ischemic ulcers may be necessary. For more severe cases, local sympathectomy can be tried, but because surgical treatment generally only provides relief for 1-2 years, it is not routinely recommended.

References:

[1] Liu Jing, Shi Qun, Xu Dong, et al. Spectrum and clinical characteristics of autoimmune diseases with Raynaud's phenomenon as the first manifestation[J]. Chinese Journal of Clinical Immunology and Allergy, 2013(04):346-350.

[2] Huang Zhiqiang, Deng Wuyi. Research progress in the treatment of Raynaud's phenomenon[J]. Chinese Journal of Medical Science, 2011, 01(24):43-44

[3] The picture is from the Chinese Rheumatology and Immunology Library;