Raynaud's Phenomenon

Overview

Journal Curr Treat Options Cardiovasc Med

Specialty Cardiology & Vascular Diseases

Date 2008 Mar 8

PMID 18325317

Authors

Ariane Herrick

Affiliations

Soon will be listed here.

Abstract

Treatment of Raynaud's phenomenon in any one individual depends on the severity of symptoms and whether or not there is an underlying disease process requiring specific intervention. Many patients with primary (idiopathic) Raynaud's phenomenon respond well to treatment with general measures, perhaps with the addition of a calcium channel blocker. Conversely, others with underlying structural vascular abnormality (as occurs in connective tissue diseases such as systemic sclerosis ) are often refractory to treatment and may progress to irreversible tissue injury, sometimes with gangrene. Because these patients are the most challenging and because a large proportion of the research into Raynaud's phenomenon has been conducted in patients with SSc-spectrum disorders, much of this review is weighted toward them. The key principles of management are removal/treatment of any triggering factor/underlying cause, general (nondrug) measures, drug treatment, and surgery, although the last is rarely indicated. New insights into pathogenesis have led, and continue to lead, to new approaches to treatment, including endothelin-1 receptor antagonism and nitric oxide supplementation.

References

Korn J, Mayes M, Cerinic M, Rainisio M, Pope J, Hachulla E . Digital ulcers in systemic sclerosis: prevention by treatment with bosentan, an oral endothelin receptor antagonist. Arthritis Rheum. 2004; 50(12):3985-93. DOI: 10.1002/art.20676. View

Yee A, Hotchkiss R, Paget S . Adventitial stripping: a digit saving procedure in refractory Raynaud's phenomenon. J Rheumatol. 1998; 25(2):269-76. View

Veale D, Collidge T, Belch J . Increased prevalence of symptomatic macrovascular disease in systemic sclerosis. Ann Rheum Dis. 1995; 54(10):853-5. PMC: 1010024. DOI: 10.1136/ard.54.10.853. View

Herrick A . Pathogenesis of Raynaud's phenomenon. Rheumatology (Oxford). 2005; 44(5):587-96. DOI: 10.1093/rheumatology/keh552. View

Pope J, Fenlon D, Thompson A, Shea B, Furst D, Wells G . Iloprost and cisaprost for Raynaud's phenomenon in progressive systemic sclerosis. Cochrane Database Syst Rev. 2000; (2):CD000953. PMC: 7032888. DOI: 10.1002/14651858.CD000953. View

McCall T, Petersen D, Wong L . The use of digital artery sympathectomy as a salvage procedure for severe ischemia of Raynaud's disease and phenomenon. J Hand Surg Am. 1999; 24(1):173-7. DOI: 10.1053/jhsu.1999.jhsu24a0173. View

Kumana C, Cheung G, Lau C . Severe digital ischaemia treated with phosphodiesterase inhibitors. Ann Rheum Dis. 2004; 63(11):1522-4. PMC: 1754817. DOI: 10.1136/ard.2003.015677. View

Herrick A, Hollis S, Schofield D, Rieley F, Blann A, Griffin K . A double-blind placebo-controlled trial of antioxidant therapy in limited cutaneous systemic sclerosis. Clin Exp Rheumatol. 2000; 18(3):349-56. View

Pope J, Fenlon D, Thompson A, Shea B, Furst D, Wells G . Ketanserin for Raynaud's phenomenon in progressive systemic sclerosis. Cochrane Database Syst Rev. 2000; (2):CD000954. PMC: 7032891. DOI: 10.1002/14651858.CD000954. View

10.

Campbell P, LeRoy E . Pathogenesis of systemic sclerosis: a vascular hypothesis. Semin Arthritis Rheum. 1975; 4(4):351-68. DOI: 10.1016/0049-0172(75)90017-7. View

11.

Allanore Y, Borderie D, Lemarechal H, Ekindjian O, Kahan A . Acute and sustained effects of dihydropyridine-type calcium channel antagonists on oxidative stress in systemic sclerosis. Am J Med. 2004; 116(9):595-600. DOI: 10.1016/j.amjmed.2003.11.022. View

12.

Pope J, Fenlon D, Thompson A, Shea B, Furst D, Wells G . Prazosin for Raynaud's phenomenon in progressive systemic sclerosis. Cochrane Database Syst Rev. 2000; (2):CD000956. PMC: 7032637. DOI: 10.1002/14651858.CD000956. View

13.

Taylor M, McFadden J, Bolster M, Silver R . Ulnar artery involvement in systemic sclerosis (scleroderma). J Rheumatol. 2002; 29(1):102-6. View

14.

Wigley F, Wise R, Seibold J, McCloskey D, Kujala G, Medsger Jr T . Intravenous iloprost infusion in patients with Raynaud phenomenon secondary to systemic sclerosis. A multicenter, placebo-controlled, double-blind study. Ann Intern Med. 1994; 120(3):199-206. DOI: 10.7326/0003-4819-120-3-199402010-00004. View

15.

Herrick A, Cerinic M . The emerging problem of oxidative stress and the role of antioxidants in systemic sclerosis. Clin Exp Rheumatol. 2001; 19(1):4-8. View

16.

THOMPSON A, Pope J . Calcium channel blockers for primary Raynaud's phenomenon: a meta-analysis. Rheumatology (Oxford). 2004; 44(2):145-50. DOI: 10.1093/rheumatology/keh390. View

17.

Coleiro B, Marshall S, Denton C, Howell K, Blann A, Welsh K . Treatment of Raynaud's phenomenon with the selective serotonin reuptake inhibitor fluoxetine. Rheumatology (Oxford). 2001; 40(9):1038-43. DOI: 10.1093/rheumatology/40.9.1038. View

18.

Wigley F, Korn J, Csuka M, Medsger Jr T, Rothfield N, Ellman M . Oral iloprost treatment in patients with Raynaud's phenomenon secondary to systemic sclerosis: a multicenter, placebo-controlled, double-blind study. Arthritis Rheum. 1998; 41(4):670-7. DOI: 10.1002/1529-0131(199804)41:4<670::AID-ART14>3.0.CO;2-I. View

19.

Merkel P, Herlyn K, Martin R, Anderson J, Mayes M, Bell P . Measuring disease activity and functional status in patients with scleroderma and Raynaud's phenomenon. Arthritis Rheum. 2002; 46(9):2410-20. DOI: 10.1002/art.10486. View

20.

Klyscz T, Junger M, Meyer H, Rassner G . Improvement of acral circulation in a patient with systemic sclerosis with stellate blocks. Vasa. 1998; 27(1):39-42. View