Study: Diagnosis & Treatment of Raynaud's Phenomenon

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The Diagnosis and Treatment of Raynaud's Phenomenon: A Practical

Approach.

Therapy In Practice

Drugs. 67(4):517-525, 2007.

Pope, Janet E

Abstract:

Raynaud's phenomenon is a common disorder with vasospasm of the

digital arteries causing pallor with cyanosis and/or rubor. It can

be primary (idiopathic), where it is not associated with other

diseases, or secondary to several diseases or conditions, including

connective tissue diseases, such as scleroderma and systemic lupus

erythematosus. Raynaud's is often mild enough to not require

treatment; however, with secondary Raynaud's there is not only

vasospasm but also fixed blood vessel defects so the ischaemia can

be more severe. Complications can include digital ulcers and could,

rarely, lead to amputation. Treatment is often non-pharmacological

including avoiding cold and smoking cessation. Calcium channel

antagonists, such as nifedipine, are often considered when treatment

is needed; however, adverse effects of these drugs can include

hypotension, vasodilatation, peripheral oedema and headaches. Other

treatments have been studied in randomised, controlled trials

including classes of drugs, such as angiotensin II inhibitors,

selective serotonin reuptake inhibitors, phosphodiesterase-5

inhibitors (e.g. sildenafil), nitrates (topical or oral; the latter

can be limited by adverse effects, such as flushing, headache and

hypotension), and for more serious Raynaud's or its complications

prostacyclin agonists may be used. There are two large studies that

demonstrate that endothelin receptor blockade with bosentan can

reduce the number of new digital ulcers in scleroderma patients.

However, it does not affect the healing period.

Thus, Raynaud's is common and often requires non-pharmacological

treatment. When secondary Raynaud's is suspected, such as Raynaud's

with an older age at onset or other features of connective tissue

disease, then an appropriate history, physical examination and

laboratory tests may be indicated to reach an appropriate diagnosis.

There have been advances in pharmacological treatment, but some of

the treatments are limited by adverse effects.