From the Guidelines
Raynaud's phenomenon is a condition where blood vessels in the fingers and toes overreact to cold temperatures or stress, causing them to narrow and temporarily limit blood flow, and the most effective management includes lifestyle changes and medications like calcium channel blockers, such as nifedipine, as first-line therapy, as recommended by the most recent evidence 1.
Definition and Pathophysiology
Raynaud's phenomenon is characterized by episodes of vasospasm in response to cold or stress, leading to a temporary reduction in blood flow to the affected areas, typically the fingers and toes. This condition can occur in two forms: primary Raynaud's, which is more common and less severe, and secondary Raynaud's, which is associated with underlying conditions like autoimmune diseases.
Management and Treatment
Management of Raynaud's phenomenon includes:
- Keeping extremities warm with gloves and socks
- Avoiding cold exposure
- Reducing stress
- Stopping smoking
- Limiting caffeine For more severe cases, medications like calcium channel blockers (such as nifedipine 30-60mg daily) may be prescribed to help dilate blood vessels, as supported by the most recent evidence 1. Additionally, PDE5 inhibitors and intravenous iloprost may be considered for treatment of SSc-RP, as recommended by the 2023 update of the EULAR recommendations 1.
Lifestyle Changes and Non-Pharmacological Management
Non-pharmacological management, such as patient education and self-management support, should be directed toward improving health-related quality of life in people with SLE and SSc, as recommended by the EULAR recommendations 1. Physical exercise and avoidance of cold exposure should also be considered for the prevention of Raynaud's phenomenon, as supported by the evidence 1.
Medications and Pharmacological Management
The most recent evidence supports the use of dihydropyridine-type calcium antagonists, usually oral nifedipine, as first-line therapy for SSc-RP, and PDE5 inhibitors and intravenous iloprost as additional treatment options for severe cases, as recommended by the 2023 update of the EULAR recommendations 1. Bosentan should be considered for reduction of number of new digital ulcers in SSc, as supported by the evidence 1.
From the Research
Definition and Characteristics of Raynaud's Phenomenon
- Raynaud's phenomenon (RP) is a vasospastic disorder characterized by episodic color changes of blanching, cyanosis, and hyperemia in response to cold and/or emotional stress 2.
- The condition typically affects the fingers, but can also affect the toes, ears, nose, and tongue.
- RP can be primary or secondary, with primary RP being more common in women and having a prevalence range of 4% to 30% in adults 2.
Diagnosis and Classification of Raynaud's Phenomenon
- LeRoy and Medsger suggested criteria for primary RP, including symmetric attacks, absence of tissue necrosis, and negative antinuclear antibodies 2.
- Secondary RP is characterized by an age of onset over 30 years, painful and asymmetric attacks, and positive autoantibodies 2.
- Systemic sclerosis has the highest frequency of RP among connective tissue diseases 2.
Treatment of Raynaud's Phenomenon
- Calcium channel blockers are the most commonly prescribed drugs for RP and have been shown to be effective in reducing the frequency of attacks 3, 4, 5.
- Nifedipine and nicardipine are the most frequently used calcium channel blockers for RP 3, 4.
- Treatment with calcium channel blockers can also reduce the severity of attacks and improve patient preference scores 3, 4, 5.
- Other treatments, such as sympatholytic agents, angiotensin II-receptor type I antagonists, and selective serotonin-reuptake inhibitors, may also be useful in some cases 2.
Efficacy and Safety of Calcium Channel Blockers
- Moderate-quality evidence suggests that calcium channel blockers are effective in reducing the frequency of attacks in primary and secondary RP 5.
- Low-quality evidence suggests that calcium channel blockers may also reduce the duration and severity of attacks, as well as improve patient global assessment and reduce pain 5.
- Common side effects of calcium channel blockers include headache, dizziness, nausea, palpitations, and ankle edema 5.
- No serious adverse events have been reported in randomized controlled trials of calcium channel blockers for RP 5.