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Current Treatment Options in Rheumatology

, Volume 4, Issue 3, pp 235–254 | Cite as

Pharmacotherapy Options in the Management of Raynaud’s Phenomenon

  • Alicia M. Hinze
  • Fredrick M. Wigley
Pain in Rheumatology (W Nielson, Section Editor)
  • 33 Downloads
Part of the following topical collections:
  1. Topical Collection on Pain in Rheumatology

Abstract

Purpose of Review

Multiple classes of medications have been studied for the treatment of Raynaud’s phenomenon (RP) with or without digital ischemia. The goal of this review is to discuss the outcomes of recent studies and to report on our approach to the management of RP in light of the available evidence.

Recent Findings

Comparing treatments for RP remains a challenge as efficacy endpoint vary widely among trials. While calcium channel blockers (CCB) are used first line in the pharmacologic management of RP, phosphodiesterase 5 inhibitors (PDE5i) have also been shown to be beneficial in reducing symptoms. In the setting of digital ischemia, administration of intravenous prostanoids is the standard of care. Bosentan an endothelin receptor antagonist (ERA), has shown benefit in the prevention of future digital ulcers in patients with scleroderma. Botulinum toxin (Btx) therapy was ineffective in a clinical trial involving scleroderma patients; more controlled studies are needed in other subsets of patients. Digital sympathectomy may be beneficial in cases of critical digital ischemia, though recurrence of symptoms is common.

Summary

Comparative effectiveness studies are needed to determine which therapeutic interventions are most beneficial in patients with RP. Based on the available evidence, we start with a CCB and add a PDE5i if symptoms are not controlled, or an intravenous prostacyclin in the setting of severe critical digital ischemia. We may additionally add an ERA in cases of recurrent digital ulcers. A surgical sympathectomy may be used in refractory cases of digital ischemia. A digital block may also be a less invasive, but temporary, intervention allowing for titration of medical therapy.

Keywords

Raynaud’s Outcomes Treatment Procedures Scleroderma Review 

Notes

Funding Information

Dr. Wigley reports grants from the Scleroderma Research Foundation and support from the Martha McCrory Professorship during the conduct of the study.

Dr. Hinze reports grants from National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award Number T32AR048522 during the conduct of the study.

Compliance with Ethical Standards

Conflict of Interest

Alicia M. Hinze declares that she has no conflict of interest. Fredrick M. Wigley declares that he has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Disclaimer

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of RheumatologyJohns Hopkins UniversityBaltimoreUSA

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