From the Guidelines
The initial treatment for Raynaud's disease should focus on conservative measures, including avoiding triggers such as cold, trauma, stress, smoking, and certain drugs, as well as wearing warm clothing and using physical therapy to stimulate blood flow, as recommended by the most recent evidence 1. To reduce the frequency and severity of attacks, patients should avoid known Raynaud phenomenon triggers, such as cold, trauma, stress, smoking, vibration injury, or certain drugs (for example, bleomycin, clonidine, and ergot alkaloids) 1.
- Wearing proper (warm) clothing in cold conditions is suggested, such as a coat, mittens, hat, dry insulated footwear, and hand and/or foot warmers, based on expert opinion 1.
- Physical therapy can be used to stimulate blood flow, for example, by teaching patients exercises to generate heat to prevent the onset of symptoms, as well as biofeedback and laser treatment 1. If conservative measures fail to provide adequate relief, medications such as calcium channel blockers (like nifedipine 30-60 mg daily in extended-release form) may be prescribed to promote vasodilation, as supported by recent evidence 1.
- Nifedipine, a dihydropyridine calcium channel blocker (CCB), is a first-line treatment for Raynaud phenomenon due to its clinical benefit, low cost, and acceptable adverse effects 1. Overall, the goal of treatment is to reduce the frequency and severity of attacks, improve blood flow, and enhance quality of life, with a focus on conservative measures and lifestyle modifications as the initial approach, as recommended by the most recent and highest-quality evidence 1.
From the Research
Initial Treatment for Raynaud's Disease
The initial treatment for Raynaud's disease typically involves lifestyle modifications and non-pharmacological approaches. Some key aspects of initial treatment include:
- Avoiding cold temperatures and smoking cessation 2, 3
- Wearing gloves to keep hands warm 3
- Assuring patients that the condition is generally not severe and will not lead to finger amputation 3
Pharmacological Treatment
When lifestyle modifications are not sufficient, pharmacological treatment may be necessary. Some common pharmacological treatments for Raynaud's disease include:
- Calcium channel blockers, such as nifedipine 2, 3, 4, 5
- Topical nitrates 6, 2
- Phosphodiesterase 5 inhibitors, such as sildenafil 2
- Endothelin antagonists 6, 2
- Angiotensin II inhibitors, such as losartan 5
- Selective serotonin reuptake inhibitors, such as fluoxetine 4
Treatment Algorithms
Treatment algorithms for Raynaud's disease may vary depending on the severity of the condition and the presence of underlying diseases. Some studies suggest that treatment algorithms should be tailored to the individual patient, taking into account factors such as disease severity, presence of digital ulcers, and response to previous treatments 6, 2.