A case–control study of candidate vasoactive mediator genes in primary Raynaud's phenomenon

Smyth, Alfred P.; Hughes, Anne E.; Bruce, Ian N.; Bell, A. L.

doi:10.1093/rheumatology/38.11.1094

Cited by 28 publications

(37 citation statements)

References 14 publications

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“…Raynaud's disease is not associated with systemic disorders, although it may occasionally be associated with other vasospastic disorders, including coronary vasospasm and migraine headaches. 4,5 Histological examination of digital arteries from patients with Raynaud's disease generally reveals no structural abnormalities. 6 However, minor changes in the microvasculature (i.e.…”

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confidence: 99%

“…9 These observations suggest that ovarian steroid hormones may facilitate the factors that underlie the disorder. It is also clear that there is an increased prevalence of Raynaud's disease in family members of affected individuals, 5,10 consistent with a genetic susceptibility to the disorder. These particular issues, together with the major factors that have been implicated in Raynaud's disease, are discussed below.…”

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confidence: 99%

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Mechanisms of Raynaud’s disease

2005

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Raynaud's phenomenon is due to transient cessation of blood flow to the digits of the hands or feet. An attack of Raynaud’s phenomenon is classically manifested as triphasic color changes. The white phase is due to excessive vasoconstriction and cessation of regional blood flow. This phase is followed by a cyanotic phase, as the residual blood in the finger desaturates. The red phase is due to hyperemia as the attack subsides and blood flow is restored. An attack is frequently associated with pain and/or paresthesia due to sensory nerve ischemia. Variants of Raynaud’s phenomenon include acrocyanosis and primary livedo reticularis, each of which is associated with reduced skin blood flow, exacerbated by cold or emotional upset. Raynaud’s phenomenon in the absence of other disorders is primary Raynaud’s phenomenon, or Raynaud’s disease. The mechanisms of Raynaud’s disease include increased activation of the sympathetic nerves, in response to cold or emotion; an impaired habituation of the cardiovascular response to stress may contribute. In addition, there appears to be a local fault, which is likely multifactorial. This local fault is due to an alteration in vascular function rather than vascular structure. The alteration in vascular function may be related to increased sensitivity to cold of the adrenergic receptors on the digital artery vascular smooth muscle. In some cases, locally released or systemically circulating vasoconstrictors may participate, including endothelin, 5-hydroxytryptamine and thromboxane. A deficiency or increased degradation of nitric oxide, possibly due to increased oxidative stress, may be involved in some cases. These recent pathophysiological insights may lead to new therapeutic options.

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Mechanisms of Raynaud’s disease

2005

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“…There seems to be a clear association between migraine headaches and Raynaud's syndrome [27,28]. Raynaud's syndrome is an episodic disorder that is characterised by attacks of rubor, primarily of the fingers, and usually provoked by cold [28].…”

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confidence: 99%

“…Raynaud's syndrome is an episodic disorder that is characterised by attacks of rubor, primarily of the fingers, and usually provoked by cold [28]. Both disorders are common in the general population and they both have a gender distribution that reflects an influence of female sex hormones [27,29].…”

Section: Discussionmentioning

confidence: 99%

“…Both disorders are common in the general population and they both have a gender distribution that reflects an influence of female sex hormones [27,29]. Episodes of either disorder may be precipitated by emotional stimuli, and for both there is also evidence for a genetic basis [28]. It has previously been suggested that migraine and Raynaud's syndrome may be part of a generalised vasospastic disorder, which also includes variant angina [30].…”

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confidence: 99%

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Migraine aura without headache compared to migraine with aura in patients with affective disorders

et al. 2005

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The characteristics of psychiatric comorbidity in migraine have been studied in migraine with aura (MA) and migraine without aura (MO). Little information is available concerning patients with migraine aura without headache. In a study of 201 patients with major affective disorders (DSM–IV) we have described the clinical characteristics of patients with these three sub–types of migraine (IHS criteria) and compared the MA and migraine aura without headache groups. Compared to patients having MA ( n =57), the group with migraine aura without headache ( n =18) had a higher age of onset of migraine (28.5 vs . 19.2, p =0.001), significantly lower prevalences of affective temperaments (28% vs . 56%, p =0.036), suicide attempts (17% vs . 53%, p =0.013) and Raynaud’s syndrome (0% vs . 25%, p =0.017). These results indicate that there seem to be differences in the clinical characteristics found in patients with migraine with aura when compared to those having the migraine subtype without a headache phase. This may convey new information concerning the comorbid expression of migraine and affective disorders or concerning the processes that differentiates the migraine types with and without a subsequent pain attack.

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