From the Guidelines
Treatment for Raynaud's phenomenon should prioritize lifestyle modifications and calcium channel blockers, such as nifedipine, as the first line of treatment to reduce the frequency and severity of attacks while preventing tissue damage. The goal of treatment is to improve circulation to the fingers and toes, and to prevent vasospasm that temporarily limits blood flow. According to the most recent and highest quality study, nifedipine is the most frequently used and recommended calcium channel blocker for the treatment of Raynaud's phenomenon 1.
Lifestyle Modifications
Lifestyle modifications are essential in the management of Raynaud's phenomenon, including:
- Keeping the entire body warm, especially in cold environments
- Wearing gloves or mittens in cold environments
- Avoiding triggers like cold exposure and stress
- Stopping smoking
- Limiting caffeine intake These non-pharmacological approaches may be sufficient for mild to moderate symptoms.
Medications
When medication is needed, calcium channel blockers like nifedipine (10-30 mg daily) are typically the first choice 1. Other medications that may be prescribed include:
- Topical nitroglycerin (applied to affected areas)
- Phosphodiesterase inhibitors like sildenafil (20-40 mg three times daily)
- Alpha-blockers such as prazosin (1-5 mg twice daily)
- Angiotensin II receptor blockers
Procedures
In severe cases that don't respond to medications, procedures like sympathectomy (surgically cutting the nerves that cause blood vessels to narrow) might be considered. However, the evidence for surgical and/or procedural treatments improving Raynaud's phenomenon is limited to small observational studies 1.
Follow-up
Regular follow-up with a healthcare provider is important to monitor the condition and adjust treatment as needed, especially if there are signs of tissue damage or if Raynaud's is secondary to another underlying condition. The treatment approach should be individualized, taking into account the severity of symptoms, the presence of underlying conditions, and the patient's response to treatment.
From the Research
Treatment Options for Raynaud's Phenomenon
- Lifestyle modifications are often recommended as the first line of treatment, including smoking cessation, avoiding low outside temperatures, and limiting repeated hand actions 2, 3
- Drug treatment options include:
- Calcium channel blockers, which are minimally effective in decreasing the frequency of attacks 4
- Nitroglycerine ointments, prostacyclins, and endothelin receptor antagonists, which have shown promise in reducing symptoms 2, 3, 5
- Phosphodiesterase inhibitors, which have been shown to be beneficial in reducing symptoms 5, 6
- Other therapeutic procedures, such as chemical or surgical sympathectomy, are considered obsolete and have no long-term positive effects 2
- In severe cases, intravenous prostanoids or digital sympathectomy may be considered 5
Pharmacological Treatment
- Calcium channel blockers are often used as first-line treatment, but may have adverse effects such as hypotension, vasodilatation, and headaches 3, 4
- Endothelin receptor antagonists, such as bosentan, have been shown to reduce the number of new digital ulcers in scleroderma patients 3, 5
- Phosphodiesterase-5 inhibitors, such as sildenafil, have been shown to be beneficial in reducing symptoms 3, 5
- Prostacyclin agonists may be used in more severe cases or in patients with digital ulcers 3, 5
Non-Pharmacological Treatment
- Avoiding cold temperatures and smoking cessation are often recommended as non-pharmacological treatments 2, 3
- Avoiding the use of vibrating tools and limiting repeated hand actions may also be beneficial 2
- Digital block may be a less invasive, but temporary, intervention allowing for titration of medical therapy 5