Buerger disease

Buerger disease is a disease in which small and medium-sized blood vessels in the arms and/or legs become inflamed and blocked (vasculitis).^[1][2] This reduces blood flow to affected areas of the body, eventually resulting damage to tissues.^[1] Symptoms of Buerger disease may include coldness, numbness, tingling or burning, and pain. Symptoms may first be felt in the fingertips or toes, and then move further up the arms or legs. Additional symptoms that may develop include changes in the texture and color of the skin, Raynaud's phenomenon, painful muscle cramps, swelling (edema), skin ulcers, and gangrene.^[2] Rare complications that have been reported include transient ischemic attacks or stroke, and heart attack.^[3]

Buerger disease almost always occurs in people who use tobacco, but it is not known exactly how tobacco plays a role in the development of the disease.^[1][4] Some people may have a genetic predisposition to Buerger disease. It is also possible that Buerger disease is an autoimmune disease, as the immune system seems to play a large role in its development.^[3][4] More research is needed to identify the exact underlying causes.^[4]

Quitting all forms of tobacco is an essential part of stopping the progression of the disease.^[4] There are no definitive treatments, but certain therapies may improve symptoms in some people.^[5] Therapies that have been reported with varying success include medications to improve blood flow and reduce the risk of clots, pain medicines, compression of the arms and legs, spinal cord stimulation, and surgery to control pain and increase blood flow. Amputation may be necessary if gangrene or a serious infection develops.^[4][5]

Buerger disease has become less common over the past ten years given the decrease in smoking prevalence and more strict diagnostic criteria. In 1947, it was estimated to occur in 104 out of 100,000 people. It now is estimated to occur in 12-20 out of 100,000 people.^[5]

Buerger disease has a strong relationship to cigarette smoking. This association may be due to direct poisoning of cells from some component of tobacco, or by hypersensitivity to the same components. Many people with Buerger disease will show hypersensitivities to injection of tobacco extracts into their skin. There may be a genetic component to susceptibility to Buerger disease as well. It is possible that these genetic influences account for the higher prevalence of Buerger disease in people of Israeli, Indian subcontinent, and Japanese descent. Certain HLA (human leukocyte antigen) haplotypes have also been found in association with Buerger disease.^[6][5]

Data is lacking regarding the association of Buerger disease with drugs or products other than cigarette smoking, however there have been case reports describing Buerger disease in patients who used other products alone or in combination with tobacco. You can search for these case reports through a service called PubMed, a searchable database of medical literature. Information on finding an article and its title, authors, and publishing details is listed here.  Some articles are available as a complete document, while information on other studies is available as a summary abstract.  To obtain the full article, contact a medical/university library (or your local library for interlibrary loan), or order it online using the following link. Using 'Buerger disease AND' followed by the name of the drug or product of interest as your search term should locate articles. To narrow your search, click on the “Limits” tab under the search box and specify your criteria for locating more relevant articles.  Click here to view a search.
http://PubMed.gov

The National Library of Medicine (NLM) Web site has a page for locating libraries in your area that can provide direct access to these journals (print or online). The Web page also describes how you can get these articles through interlibrary loan and Loansome Doc (an NLM document-ordering service). You can access this page at the following link http://nnlm.gov/members/. You can also contact the NLM toll-free at 888-346-3656 to locate libraries in your area.