The patient with cold hands: understanding Raynaud's disease

A non-invasive technique for the evaluation of peripheral circulatory functions in female subjects with Raynaud's phenomenon

Japanese women now account for 43 percent of the labor force. A number of them are involved in construction, agricultural and forestry jobs. The aim of this study was to establish a non-invasive technique for the evaluation of peripheral circulatory functions in women with Raynaud's phenomenon (RP) and introduce a specific method for the assessment of vascular disturbances in females exposed to hand-transmitted vibration. The subjects of this study were 10 women with primary RP, 7 women with progressive systemic sclerosis (PSS) secondary to RP, and 17 females who were included as the control group. The evaluation of peripheral circulatory functions in all subjects was based on the values of finger blood flow (FBF) and finger skin temperature (FST) measured before, during and following a 5-min recovery period after the hand was immersed in cold water (5°C, 1 min). The measured values of FBF and FST of the primary RP group before and after the immersion test were significantly (p<0.01) lower compared to those of the control group. The technique applied in this study could be used as a non-invasive and tolerable technique to determine the digital circulatory functions in female subjects with RP.

Raynaud's Phenomenon: A Brief Review of the Underlying Mechanisms

Raynaud’s phenomenon (RP) is characterized by exaggerated cold-induced vasoconstriction. This augmented vasoconstriction occurs by virtue of a reflex response to cooling via the sympathetic nervous system as well as by local activation of α_2C adrenoceptors (α_2C-AR). In a cold-initiated, mitochondrion-mediated mechanism involving reactive oxygen species and the Rho/ROCK pathway, cytoskeletal rearrangement in vascular smooth muscle cells orchestrates the translocation of α_2C-AR to the cell membrane, where this receptor readily interacts with its ligand. Different parameters are involved in this spatial and functional rescue of α_2C-AR. Of notable relevance is the female hormone, 17β-estradiol, or estrogen. This is consistent with the high prevalence of RP in premenopausal women compared to age-matched males. In addition to dissecting the role of these various players, the contribution of pollution as well as genetic background to the onset and prevalence of RP are also discussed. Different therapeutic approaches employed as treatment modalities for this disease are also highlighted and analyzed. The lack of an appropriate animal model for RP mandates that more efforts be undertaken in order to better understand and eventually treat this disease. Although several lines of treatment are utilized, it is important to note that precaution is often effective in reducing severity or frequency of RP attacks.