From the Guidelines
Finger soreness in scleroderma should be treated with dihydropyridine-type calcium antagonists, such as oral nifedipine, as first-line therapy to improve circulation and reduce pain. According to the 2023 EULAR recommendations for the treatment of systemic sclerosis 1, this approach is supported by a high level of evidence (1a) and a strong strength of recommendation (A).
Causes of Finger Soreness
Finger soreness in scleroderma can be caused by several factors, including:
- Raynaud's phenomenon (SSc-RP)
- Digital ulcers
- Joint inflammation
- Skin fibrosis
Treatment Options
Treatment options for finger soreness in scleroderma include:
- Dihydropyridine-type calcium antagonists, such as oral nifedipine, as first-line therapy 1
- PDE5 inhibitors, such as sildenafil, as an alternative or adjunct therapy 1
- Topical nitroglycerin (2% ointment) to improve blood flow in severe cases
- Physical therapy with gentle stretching exercises to maintain finger mobility and reduce stiffness
- Moisturizing regularly with fragrance-free creams to manage skin tightening and dryness
Preventive Measures
Preventive measures to reduce finger soreness in scleroderma include:
- Keeping hands warm with gloves
- Avoiding cold exposure
- Using hand warmers
- Avoiding smoking and other vasoconstrictive substances
Monitoring and Follow-up
Regular monitoring and follow-up with a healthcare provider are essential to assess the effectiveness of treatment and adjust the treatment plan as needed. If digital ulcers develop or pain becomes severe, prompt medical attention is necessary, and more aggressive treatments like vasodilators or immunosuppressants may be required 1.
From the Research
Finger Soreness in Scleroderma
- Finger soreness in scleroderma is often associated with digital ulcers, which are a common complication in patients with scleroderma 2.
- Digital ulcers can be resistant to conventional therapies and may require a combination of nonoperative and operative treatments 3, 4.
- Nonoperative treatment options for digital ulcers in scleroderma include:
- Cessation of vasoconstrictive agents
- Nifedipine
- Biofeedback
- Digital xylocaine blockade
- Silver sulfadiazine topical ointment 3
- Operative treatment options for digital ulcers in scleroderma include:
- Calcium-channel blockers, such as nifedipine, have been shown to be effective in reducing the frequency and severity of ischemic attacks in patients with Raynaud's phenomenon secondary to scleroderma 5.
Management of Digital Ulcers
- The management of digital ulcers in scleroderma requires a multidisciplinary approach, including medical and surgical treatments 6, 4.
- A decision tree for the management of digital ulcers in scleroderma has been proposed, which takes into account the severity of the ulcers and the patient's overall health status 4.
- The goal of treatment is to eradicate the ulcer, reduce or eliminate pain, and return the hand to useful function 4.