Vasomotor tone and vascular responses to local cold in primary Raynaud's disease

Effects of general and thematically relevant stressors in Raynaud's disease

Emotional stress has been reported to cause vasospastic attacks in some patients with idiopathic Raynaud's disease. In the present study, the physiological and subjective responses of 32 Raynaud's disease patients and 22 normal subjects to three imagined scenes were compared. Both groups responded similarly to a neutral and a generally stressful scene. However, a scene having content thematically relevant to Raynaud's disease produced decreased finger temperature in these patients but not in normal controls. These findings are discussed in terms of stimulus specificity and social learning theories.

Role of cold and emotional stress in Raynaud's disease and scleroderma

Research on the aetiology of Raynaud's disease and phenomenon has been hindered by the difficulty of provoking attacks in the laboratory. A study was therefore conducted in which digital and ambient temperatures, electrocardiograms, and stress ratings were obtained during ambulatory monitoring in patients with idiopathic Raynaud's disease, Raynaud's phenomenon secondary to scleroderma, and in normal subjects. In Raynaud's disease about one third of the vasospastic attacks were associated with tachycardia and increased stress ratings without declines in ambient temperature. In contrast, cold alone was enough to provoke most attacks of Raynaud's phenomenon in scleroderma. Chronically increased stress ratings in patients with scleroderma and increased muscle tension in anticipation of a cold stimulus suggest that these patients have different patterns of stress responses from those with Raynaud's disease.

Controlled trial of plasma exchange in treatment of Raynaud's syndrome

Twenty-seven patients with Raynaud's syndrome had their digital vessel patency assessed by Doppler ultrasound after different thermal stresses. Digital vessel patency rates differed significantly after stresses at 15 degrees C and 45 degrees C. In a randomised controlled trial placebo and heparin had no effect either on patients' symptoms or on the patency of their digital vessels. Plasma exchange improved both symptoms and vessel patency rates at 15 degrees C and 21 degrees C. Improvement in seven out of eight of these patients has been maintained for six months. Assessing digital vessel patency by Doppler techniques allow continuous, atraumatic, and safe evaluation of the effects of different methods of treatment on the patency of the digital vessels and has helped to indicate that plasma exchange is a useful adjunct in the management of patients with severe Raynaud's syndrome.

Raynaud's disease: reduced hand blood flows with normal blood viscosity

Hand blood flows and the blood and plasma viscosities were measured in patients with Raynaud's disease in an attempt to identify the mechanism of the episodic vascular insufficiency. Using venous occlusion plethysmography the following observations were made: (1) the hand blood flows were significantly less than in normals at 32 degrees, 27 degrees and 20 degrees C; (2) the percentage decrease in flow with cooling was greater in normals and (3) cooling of one hand from 32 degrees to 27 degrees C caused an abnormal decrease in flow through the contralateral hand. Using a rotational viscometer the blood and plasma viscosities were found to be normal at both high and low shear rates. The percentage increase in the blood viscosity with cooling from 35 degrees to 25 degrees was also normal. These studies demonstrate an increased constrictive response of the cutaneous vasculature of the hand to both local and reflex stimulation, and exclude a rheological abnormality, under conditions similar to those of the present study.