Clinical and Pathogenetical Peculiarities of the Secondary Raynaud’s Syndrome and Their Pharmacological Correction

Introduction. The prevalence of Raynaud's syndrome in different countries ranges from 2.1 – to 16.8 %. Secondary Raynaud's syndrome (SRS) occurs in case of more than 70 diseases. However, there is no consensus about the pathogenic mechanisms of its origin, and the modern diagnosis algorithms, without which it is difficult to choose the correct treatment that influences the patients' disability prognosis and his life quality, are not elaborated. The purpose of the study is to ascertain the clinical and pathogenetic peculiarities of SRS of different severity degrees, to work out the algorithms for its diagnosis and increase the effectiveness of treatment with candesartan. Materials and methods. The work is based on the results of the survey of 120 patients with SRS. The diagnosis of SRS is carried out using the criteria of E. Allen, G. Brown. Among the 120 surveyed patients there were 101 women and 19 men, average age – 48,5 (17,0–73,0) [34,0–56,0] years in the ratio of 5:1. Results and discussion. The first group consisted of 44 (36.7 %) patients with mild severity. The method of widefield capillaroscopy revealed angiodystonic changes of capillaries in such patients. The second group of patients consisted of 53 persons (44.2 %) with moderate severity of SRS, that was characterized by the presence of attacks, mainly in the cold season, with more pronounced than in the first group subjective disorders such as tingling or pain in fingers with manifestations of trophic changes in most of them. During the capillaroscopic examination in patients with the moderate severity degree of SRS, there were found similar changes as in the patients of the first group, but with a reduction of the capillary net. The third group consisted of 23 patients (19.2 %) with severe severity degree of SRS. There were found pronounced capillaroscopic changes: spastic and atonic state of capillaries, resize and form changing of the capillary loops, reduction of capillary grid, the presence of megacapillaries and non-vascular fields, local ischemia, an acute deceleration of the blood flow, venous stasis. These indices were studied in the patients in dynamics after the treatment with candesartan during one and four months (short-term and long-term courses of treatment). For the patients there was conducted written survey within a month using a questionnaire, which showed subjective improvement of the clinical status of respondents with moderate and severe courses of SRS. Conclusions. The conducted by us pathogenetic correction of SRS with candesartan favorably influenced, in the first place, the state of the bloodstream of the upper limbs at all clinical degrees of its severity. These positive changes were confirmed by the data obtained from the patients' questionnaire, that showed the reduced levels of pain in case of the moderate and severe course, according to VAS, and the index of attacks' duration in case of severe course of SRS.