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1.
Ann Biomed Eng ; 52(6): 1732-1743, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38530533

RESUMEN

Raynaud's phenomenon (RP) is a condition that causes decreased blood flow to areas perfused by small blood vessels (e.g., fingers, toes). In severe cases, ulceration, gangrene, and loss of fingers may occur. Most treatments focus on inducing vasorelaxation in affected areas by the way of pharmaceuticals. Recently, animal studies have shown that vasorelaxation can be induced by non-coherent blue light (wavelength ~ 430-460 nm) through the actions of melanopsin, a photoreceptive opsin protein encoded by the OPN4 gene. To study this effect in humans, a reliable phototherapy device (PTD) is needed. We outline the construction of a PTD to be used in studying blue light effects on Raynaud's patients. Our design addresses user safety, calibration, electromagnetic compatibility/interference (EMC/EMI), and techniques for measuring physiological responses (temperature sensors, laser Doppler flow sensors, infrared thermal imaging of the hands). We tested our device to ensure (1) safe operating conditions, (2) predictable, user-controlled irradiance output levels, (3) an ability for measuring physiological responses, and (4) features necessary to enable a double-blinded crossover study for a clinical trial. We also include in the Methods an approved research protocol utilizing our device that may serve as a starting point for clinical study. We introduced a reliable PTD for studying the effects of blue light therapy for patients suffering from Raynaud's phenomenon and showed that our device is safe and reliable and includes the required measurement vectors for tracking treatment effects throughout the duration of a clinical study.


Asunto(s)
Fototerapia , Enfermedad de Raynaud , Adulto , Femenino , Humanos , Masculino , Luz Azul , Fototerapia/instrumentación , Enfermedad de Raynaud/terapia , Enfermedad de Raynaud/fisiopatología
2.
Acupunct Med ; 41(2): 63-72, 2023 04.
Artículo en Inglés | MEDLINE | ID: mdl-35608095

RESUMEN

OBJECTIVE: To assess the effectiveness of acupuncture for the treatment of Raynaud's syndrome by conducting a systematic review and meta-analysis of randomized controlled trials (RCTs). METHODS: Studies were identified from English and Chinese databases from their inception to September 2020. The outcomes of interest were remission incidence, number of daily attacks, incidence of positive cold stimulation tests and incidence of cold provocation tests. We conducted meta-analysis and network meta-analysis using meta and gemtc. RESULTS: Six trials (n = 272 participants) were included in the meta-analysis. Pairwise meta-analyses show that acupuncture was associated with increased remission incidence (risk ratio (RR) = 1.21, 95% confidence interval (CI) = 1.10 to 1.34), decreased daily number of attacks (weighted mean difference (WMD) = -0.57, 95% CI = -1.14 to -0.01), and increased incidence of positive cold stimulation tests (RR = 1.64, 95% CI = 1.27 to 2.11). There was not enough evidence to associate acupuncture with decreased incidence of positive cold provocation tests. The network meta-analyses did not demonstrate significant results for the effectiveness of any acupuncture treatments (electroacupuncture or manual acupuncture ± moxibustion), compared with controls, in terms of remission incidence or daily number of attacks, possibly due to small sample sizes and a lack of statistical power. CONCLUSION: The use of acupuncture may be effective for the treatment of Raynaud's syndrome in terms of increasing remission incidence, decreasing daily number of attacks and increasing incidences of positive cold stimulation tests. However, our findings should be interpreted with caution due to small sample sizes, very low quality of evidence and high risk of bias. Future large-scale RCTs are warranted.


Asunto(s)
Terapia por Acupuntura , Enfermedad de Raynaud , Humanos , Terapia por Acupuntura/métodos , Ensayos Clínicos Controlados Aleatorios como Asunto , Enfermedad de Raynaud/terapia , Resultado del Tratamiento
3.
Rev Med Interne ; 43(10): 596-602, 2022 Oct.
Artículo en Francés | MEDLINE | ID: mdl-35835622

RESUMEN

Paroxysmal vascular acrosyndromes are related to a peripheral vasomotor disorder and presented as paroxysmal color changes of the fingers. They include primary Raynaud's phenomenon (RP), which is the most common, secondary RP and erythermalgia. They are to be distinguished from non-paroxysmal acrosyndromes such as acrocyanosis and chilblains, which are very frequent and often associated with RP, digital ischemia and necrosis, spontaneous digital hematoma and acrocholosis. The challenge of a consultation for a vascular acrosyndrome is to make positive diagnosis through history and clinical examination, and to specify its nature, to prescribe complementary exams. In any patient consulting for RP, assessment includes at least an antinuclear antibody test and capillaroscopy. For erythermalgia, a blood count and even a search for JAK2 mutation are required. A thryoid-stimulating hormon assay, a test for antinuclear antibodies, and a search for small fiber neuropathy are also performed. The treatment of RP is essentially documented for secondary RP where calcium channel blockers are indicated in first line, and iloprost in severe cases. The treatment of primitive erythermalgia is based on sodium channel blockers such as mexiletine or lidocaine infusions, and on drugs effective on neuropathic pain, such as gabapentin or amitryptiline, in case of erythermalgia associated with small fiber neuropathy. The treatment of erythermalgia associated with myeloproliferative syndromes is based on etiological treatment and aspirin.


Asunto(s)
Eritromelalgia , Enfermedad de Raynaud , Neuropatía de Fibras Pequeñas , Anticuerpos Antinucleares , Aspirina , Bloqueadores de los Canales de Calcio/uso terapéutico , Gabapentina , Humanos , Iloprost , Lidocaína , Mexiletine , Enfermedad de Raynaud/diagnóstico , Enfermedad de Raynaud/etiología , Enfermedad de Raynaud/terapia , Bloqueadores de los Canales de Sodio/uso terapéutico
4.
Reumatol Clin (Engl Ed) ; 18(4): 246-248, 2022 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-34953734

RESUMEN

We describe 4 patients with Raynaud's phenomenon associated with systemic sclerosis, 3 with ischaemic ulcers, successfully treated with hyperbaric oxygen. This therapy has been useful in the treatment of chronic wounds due to its anti-inflammatory, antimicrobial and angiogenic effects. Hyperbaric oxygen treatment could be a therapeutic option in patients with Raynaud's phenomenon refractory to conventional treatment.


Asunto(s)
Oxigenoterapia Hiperbárica , Enfermedad de Raynaud , Esclerodermia Sistémica , Humanos , Enfermedad de Raynaud/complicaciones , Enfermedad de Raynaud/terapia , Esclerodermia Sistémica/complicaciones , Esclerodermia Sistémica/terapia , Úlcera/complicaciones , Úlcera/tratamiento farmacológico
5.
Undersea Hyperb Med ; 47(3): 491-530, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32931678

RESUMEN

The use of hyperbaric oxygen (HBO2) for the treatment of selected problem wounds has focused almost entirely on the diabetic foot ulcer (DFU) in recent years. The prevalence of DFUs in today's patient population and the reimbursement available for the treatment of DFUs have given it priority status in discussions about problem wounds, but there are sound fundamental reasons why additional oxygen may have benefits in the treatment of non-DFU wounds.


Asunto(s)
Oxigenoterapia Hiperbárica/métodos , Oxígeno/fisiología , Úlcera Cutánea/terapia , Cicatrización de Heridas/fisiología , Heridas y Lesiones/terapia , Anemia de Células Falciformes/complicaciones , Calcifilaxia/terapia , Pie Diabético/fisiopatología , Pie Diabético/terapia , Enfermedad Injerto contra Huésped/terapia , Humanos , Recuperación del Miembro , Metaanálisis como Asunto , Presión Parcial , Selección de Paciente , Enfermedad Arterial Periférica/fisiopatología , Enfermedad Arterial Periférica/terapia , Guías de Práctica Clínica como Asunto , Piodermia Gangrenosa/fisiopatología , Piodermia Gangrenosa/terapia , Ensayos Clínicos Controlados Aleatorios como Asunto , Enfermedad de Raynaud/fisiopatología , Enfermedad de Raynaud/terapia , Esclerodermia Sistémica/fisiopatología , Esclerodermia Sistémica/terapia , Úlcera Cutánea/etiología , Úlcera Cutánea/fisiopatología , Revisiones Sistemáticas como Asunto , Resultado del Tratamiento , Revisión de Utilización de Recursos , Heridas y Lesiones/complicaciones
6.
Clin Rehabil ; 34(5): 595-606, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32141306

RESUMEN

OBJECTIVE: To analyze the effectiveness of an electrotherapy intervention with galvanic current on symptoms associated with Raynaud's phenomenon. DESIGN: Single-blind randomized controlled trial, parallel design (1:1 ratio) and intention-to-treat analysis. SETTING: Virgen de las Nieves Hospital, Granada, Spain. SUBJECTS: Thirty-four participants with Raynaud's phenomenon, with a mean (SD) age of 43.43 (17.62) years. INTERVENTIONS: The patients were randomly assigned to a control group with conservative treatment (anti-inflammatory, vasodilatory and analgesic drugs) or an intervention group that received conservative treatment and vasodilatory electrical stimulation during seven weeks, three times/week for a total of 20 sessions. MAIN MEASURES: The primary outcome was the number of attacks. Secondary outcomes were pain, peripheral blow flow, oxygen saturation, upper limb disability, central sensitization, pain catastrophizing and temperature recovery. All outcomes were assessed at baseline, posttreatment and at two months of follow-up. RESULTS: The galvanic current electrotherapy group showed significantly greater improvements in the number of attacks (mean difference = 26.3, 95% confidence interval (CI) = 14.4 to 38.3), pre-cold stress pain (95% CI = 0.6 to 2.4), radial artery blood flow (95% CI = -7.8 ⩾ x ⩽ 1.3), ulnar artery blood flow (95% CI = -8.63 to 0.60), oxygen saturation (95% CI = -1.7 ⩾ x ⩽ -0.29), upper limb disability (95% CI = 1.1 to 22.3), central sensitization (95% CI = 6.7 to 18.2) and temperature recovery (95% CI = -5.7 ⩾ x ⩽ -0.32) than the conservative treatment group. CONCLUSION: This study suggests that a complementary treatment with galvanic current in combination to conservative approach is superior to conservative applied as isolate, in reducing the clinical manifestations and disability in Raynaud's phenomenon.


Asunto(s)
Tratamiento Conservador , Terapia por Estimulación Eléctrica , Enfermedad de Raynaud/terapia , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedad de Raynaud/fisiopatología , Método Simple Ciego , España , Resultado del Tratamiento , Vasodilatación
7.
Acta Dermatovenerol Croat ; 28(3): 166-170, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33422171

RESUMEN

Episodes of excessive vasospasm are common in patients with Raynaud's phenomenon (RP). Pharmacological treatment may often result in side-effects such as hypotension, leading to discontinuation of treatment. Review of therapeutic interventions with regard to tendency towards hypotension was done in medical databases including PubMed, Scopus, and Medline to summarize the current state of the knowledge. Despite the episodes of blood pressure drops caused by hypotension, calcium channel blockers (CCB) have been widely used in RP as first-line treatment medication. The use of other CCB apart from nifedipine is controversial due to the variety of results in clinical trials. A clinical study comparing the efficacy and tolerability of losartan with nifedipine revealed a significant reduction in RP severity, frequency of episodes, and reported adverse effects. Application of oral sildenafil 100 mg/d as an add-on therapy increased microvascular blood flow in secondary RP, while being well-tolerated and with no withdrawal from the study. Topical vasodilators may be applied as an adjuvant therapy for patients with RP. Clinical studies approved 10% nifedipine cream and 10% nitroglycerine gel as an efficient RP therapy with side-effects comparable with placebo usage. Non-pharmacological interventions, such as cold avoidance, stress management, and smoking cessation are recommended in reducing episodes of RP. Calcium channel blockers, with a particular emphasis on nifedipine, in combination with non-pharmacological management seem to be the optimal way to treat the patients with a tendency to hypotension.


Asunto(s)
Hipotensión/etiología , Enfermedad de Raynaud/complicaciones , Enfermedad de Raynaud/terapia , Antihipertensivos/uso terapéutico , Bloqueadores de los Canales de Calcio/uso terapéutico , Humanos , Hipotensión/inducido químicamente , Losartán/uso terapéutico , Nifedipino/uso terapéutico , Nitroglicerina/uso terapéutico , Citrato de Sildenafil/uso terapéutico , Cese del Hábito de Fumar , Estrés Psicológico/prevención & control , Vasodilatadores/uso terapéutico
8.
Clin Dermatol ; 36(4): 498-507, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30047433

RESUMEN

Raynaud's phenomenon (RP) is a transient, acral, vasospastic phenomenon that manifests with characteristic color changes. This vasospasm, classically triggered by cold temperatures, may also be driven by shifts in temperature, climate, or emotional state. Primary RP (PRP) is a common condition without severe sequelae. Secondary RP (SRP), which may be driven by vascular, autoimmune, hematologic, or endocrine etiologies, can result in digital ulceration, irreversible ischemia and necrosis, and secondary infection. This review delineates the clinical manifestations of both primary and secondary RP, as well as the current understanding of RP epidemiology and pathogenesis. Proper examination, including nailfold capillary microscopy, and laboratory workup for secondary causes of RP are also discussed. The traditional armamentarium of therapies used for RP, as well as newer medical and surgical options, is also summarized with particular regard to the clinical evidence for their efficacy.


Asunto(s)
Enfermedad de Raynaud/diagnóstico , Enfermedad de Raynaud/terapia , Administración Cutánea , Antagonistas de Receptores de Angiotensina/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Anticoagulantes/uso terapéutico , Antihipertensivos/uso terapéutico , Toxinas Botulínicas Tipo A/uso terapéutico , Bloqueadores de los Canales de Calcio/uso terapéutico , Antagonistas de los Receptores de Endotelina/uso terapéutico , Epoprostenol/uso terapéutico , Humanos , Hipertermia Inducida , Fármacos Neuromusculares/uso terapéutico , Nitroglicerina/administración & dosificación , Educación del Paciente como Asunto , Inhibidores de Fosfodiesterasa 5/uso terapéutico , Enfermedad de Raynaud/complicaciones , Enfermedad de Raynaud/epidemiología , Inhibidores Selectivos de la Recaptación de Serotonina/uso terapéutico , Simpatectomía , Vasodilatadores/uso terapéutico
9.
J Med Case Rep ; 10(1): 356, 2016 Dec 20.
Artículo en Inglés | MEDLINE | ID: mdl-27998297

RESUMEN

BACKGROUND: Raynaud's phenomenon is a microvascular disorder that results in exaggerated vasoconstriction over vasodilatation secondary to an alteration in autonomic control. Though benign, it can result in severe ulceration and ultimately gangrene associated with disfiguration and permanent deformity. We present a case of severe secondary Raynaud's phenomenon in a black-African patient from a resource-limited setting, with focus on the difficulties encountered in the diagnosis and treatment. CASE PRESENTATION: A 43-year-old female Cameroonian farmer with a 7-year history of episodic paresthesia in her fingers and toes (when exposed to cold) presented to our emergency department with severe pain, ulceration, and "darkening" of her fingertips over a period of 2 days. An examination revealed bilateral ulceration and dry gangrene of her fingers and toes, based on which a diagnosis of secondary Raynaud's phenomenon due to a connective tissue disease was proposed. Results of paraclinical investigations were normal. Lifestyle modification along with a calcium channel blocker and phosphodiesterase type 5 inhibitor provided significant relief. CONCLUSIONS: An early diagnosis and knowledge on appropriate treatment of Raynaud's phenomenon is of vital importance to prevent permanent tissue damage and disability. Relying on biphasic color change for the diagnosis of Raynaud's phenomenon in black Africans can be potentially misleading.


Asunto(s)
Enfermedades del Tejido Conjuntivo/complicaciones , Consejo Dirigido , Dedos/patología , Microcirculación/efectos de los fármacos , Enfermedad de Raynaud/patología , Conducta de Reducción del Riesgo , Dedos del Pie/patología , Adulto , Analgésicos Opioides/uso terapéutico , Antibacterianos/uso terapéutico , Población Negra , Bloqueadores de los Canales de Calcio/uso terapéutico , Cloxacilina/uso terapéutico , Enfermedades del Tejido Conjuntivo/patología , Femenino , Gangrena , Humanos , Estilo de Vida , Nifedipino/uso terapéutico , Inhibidores de Fosfodiesterasa 5/uso terapéutico , Enfermedad de Raynaud/complicaciones , Enfermedad de Raynaud/terapia , Índice de Severidad de la Enfermedad , Citrato de Sildenafil/uso terapéutico , Tramadol/uso terapéutico , Resultado del Tratamiento
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