From the Guidelines
Raynaud syndrome patients should be treated with a combination of lifestyle modifications and medications, with calcium channel blockers such as nifedipine being the first-line treatment, as recommended by the most recent and highest quality study 1. The treatment of Raynaud syndrome focuses on preventing attacks by keeping extremities warm with gloves, socks, and avoiding cold exposure.
- Lifestyle modifications like avoiding caffeine, not smoking, and stress management techniques are recommended for mild cases.
- For more severe cases, medications such as calcium channel blockers (like nifedipine 30-60mg daily) are first-line treatments to help relax blood vessels.
- Other options include topical nitroglycerin, phosphodiesterase inhibitors (sildenafil), or alpha-blockers (prazosin).
- In extreme cases that don't respond to medication, nerve surgery (sympathectomy) may be considered. Raynaud's occurs in two forms: primary (idiopathic) which is generally milder, and secondary, which is associated with underlying conditions like autoimmune disorders. The condition affects blood vessels through abnormal sympathetic nervous system activation, causing excessive vasoconstriction in response to triggers, as noted in a recent study 1. Most people can manage symptoms effectively with proper precautions and treatment when necessary, and physical exercise should be considered as part of the non-pharmacological management of systemic sclerosis, as recommended by a recent study 1. Avoidance of cold exposure is also crucial in preventing Raynaud’s phenomenon, especially in people with systemic sclerosis, as highlighted in a recent study 1.
From the Research
Definition and Characteristics of Raynaud Syndrome
- Raynaud's phenomenon is a common condition characterized by vasospasm of the digital arteries and resulting cyanosis and redness 2.
- It is often described as an exaggerated vasospastic response to cold or emotion, classically causing the digits (fingers and toes) to turn white, then blue, then red 3, 4, 5.
Treatment Options
- Calcium channel blockers are the most commonly prescribed drugs for people with primary Raynaud's phenomenon and are often used first-line in the pharmacologic management of Raynaud's phenomenon 2, 3, 4, 5.
- Phosphodiesterase 5 inhibitors have also been shown to be beneficial in reducing symptoms 6.
- In the setting of digital ischemia, administration of intravenous prostanoids is the standard of care, and bosentan has shown benefit in the prevention of future ulcers in patients with scleroderma 6.
- Botulinum toxin therapy was ineffective in a clinical trial involving scleroderma patients, and more controlled studies are needed in other subsets of patients 6.
- Digital sympathectomy may be beneficial in cases of critical digital ischemia, though recurrence of symptoms is common 6.
Efficacy of Calcium Channel Blockers
- Treatment with oral calcium channel blockers was minimally effective in primary Raynaud's phenomenon at decreasing the frequency of attacks 3, 4.
- Calcium channel blockers reduced the average number of attacks per week by 1.72 (95% CI 0.60 to 2.84) compared to placebo 3, 4.
- The average duration of attacks did not differ in a statistically significant or clinically meaningful way between calcium channel blockers and placebo 5.
- Calcium channel blockers reduced attack severity by 0.62 cm (95% CI -0.72 to -0.51) on a 10-cm visual analogue scale 5.
Adverse Reactions
- Treatment with calcium channel blockers appeared to be associated with a number of adverse reactions, including headaches, flushing, and oedema (swelling) 3, 4, 5.
- Withdrawals from studies due to adverse effects were more common with calcium channel blockers than with placebo, but no serious adverse events were reported 5.