From the Guidelines
Treatment of acute Raynaud's disease should prioritize non-pharmacological measures and calcium channel blockers as the first-line approach to relieve symptoms and prevent tissue damage. The management of Raynaud's phenomenon involves avoiding triggers such as cold, trauma, stress, smoking, vibration injury, or certain drugs like bleomycin, clonidine, and ergot alkaloids 1. Wearing proper clothing in cold conditions, such as a coat, mittens, hat, dry insulated footwear, and hand and/or foot warmers, is suggested based on expert opinion 1.
Non-Pharmacological Measures
- Avoiding cold exposure
- Wearing gloves in cold environments
- Stopping tobacco use since nicotine constricts blood vessels
- Physical therapy to stimulate blood flow, including exercises to generate heat, biofeedback, and laser treatment 1
Medication Management
- Calcium channel blockers like nifedipine (10-20 mg three times daily) are typically the first choice as they dilate blood vessels and improve circulation 1
- Topical nitroglycerin (apply 2% ointment to affected digits)
- Phosphodiesterase inhibitors such as sildenafil (20-40 mg three times daily)
- Alpha-blockers like prazosin (1-5 mg twice daily)
Severe Cases
- Intravenous prostacyclins like iloprost may be necessary in cases with tissue ischemia 1
- Digital sympathetic nerve block might be performed for acute severe attacks not responding to other treatments
It's essential to identify and treat any underlying conditions contributing to Raynaud's, such as autoimmune disorders, as this can improve overall management of the disease 1. Alternative treatments like acupuncture, antioxidants, biofeedback, and therapeutic gloves have shown inconclusive results, with only ceramic-impregnated gloves potentially improving Raynaud phenomenon with minimal benefit 1.
From the Research
Treatment Options for Acute Raynaud's Disease
- Lifestyle modifications are recommended as the first-line management for all patients with Raynaud's phenomenon (RP) 2
- Pharmacologic therapies may include:
- Additional approaches to treatment for those with signs of critical ischemia or those who fail pharmacologic therapy include:
- Non-pharmacological treatment options include:
Pharmacological Treatment
- Calcium channel blockers are often considered as the first-line treatment for RP 3, 4, 5, 6
- Phosphodiesterase 5 inhibitors have been shown to be beneficial in reducing symptoms 4
- Endothelin receptor blockade with bosentan can reduce the number of new digital ulcers in scleroderma patients 3, 4
- Intravenous prostanoids are the standard of care in the setting of digital ischemia 4