What is the treatment for Raynaud's (Raynaud's disease or Raynaud's phenomenon)?

From the Guidelines

Raynaud's treatment should focus on managing symptoms and preventing attacks by avoiding cold exposure and stress, and using medications like calcium channel blockers such as nifedipine (10-30 mg daily) as first-line treatments. The primary recommendation is to avoid cold exposure and stress, which are common triggers, and to keep hands and feet warm with gloves, socks, and hand warmers during cold weather 1. For mild symptoms, lifestyle modifications are usually sufficient. For more severe cases, medications like calcium channel blockers such as nifedipine (10-30 mg daily) or amlodipine (5-10 mg daily) are first-line treatments, helping to relax blood vessels and improve circulation 1.

Treatment Options

• Topical nitroglycerin ointment (2%) applied to affected fingers can provide relief during acute attacks 1
• For patients with severe symptoms unresponsive to medications, phosphodiesterase inhibitors like sildenafil (20 mg three times daily) may be considered 1
• In extreme cases with tissue damage, prostacyclin analogs like iloprost may be used 1
• Regular follow-up is important to assess treatment effectiveness and adjust therapy as needed, especially if digital ulcers develop

Medication Considerations

• Nifedipine is a first-line treatment for Raynaud phenomenon as it has some clinical benefit, low cost, and acceptable adverse effects 1
• Other calcium channel blockers (primarily the dihydropyridine type) can be considered if there is a lack of benefit from or tolerability of nifedipine 1
• Phosphodiesterase type 5 (PDE-5) inhibitors reduce the frequency and severity of Raynaud’s phenomenon attacks, and should be considered in treatment 1

From the Research

Treatment Options for Raynaud's Phenomenon

• Non-pharmacological treatments are often considered first, including avoiding cold and smoking cessation 2
• Calcium channel antagonists, such as nifedipine, are commonly used when treatment is needed, but can have adverse effects like hypotension and headaches 2, 3, 4
• Other treatments that have been studied include:
  • Angiotensin II inhibitors
  • Selective serotonin reuptake inhibitors
  • Phosphodiesterase-5 inhibitors (e.g. sildenafil)
  • Nitrates (topical or oral)
  • Prostacyclin agonists for more serious cases or complications 2
  • Endothelin receptor blockade with bosentan, which can reduce the number of new digital ulcers in scleroderma patients 2
  • Endothelin-1 receptor antagonists and nitric oxide donors 5
  • Botulinum toxin 6

Pharmacological Treatment

• Calcium channel blockers, such as nifedipine and diltiazem, have been shown to produce subjective improvement in 60 to 90% of cases 3, 4
• Nifedipine has been found to decrease the frequency of vasospastic episodes and provide moderate or marked subjective improvement in 60% of patients 4
• Newer therapies, such as endothelin antagonists, phosphodiesterase-5 inhibitors, and antioxidants, are being explored for patients with severe symptoms or intolerance to available therapies 6

Considerations for Treatment

• The exact approach to treatment will vary depending on the nature and severity of the underlying digital vascular problem 5
• Patients with underlying vascular disease or connective tissue diseases may require different treatment approaches 2, 3, 4
• Prompt assessment and treatment of acute digital ischemia is necessary, as it is a medical emergency 5