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Raynaud's Treatments

Author: Shelley Ensz. Scleroderma is highly variable. See Types of Scleroderma. Read Disclaimer
Video Overview
Mild Cases
Amputation
Biofeedback
Botox
Diet, Lifestyle, Smoking
Digital Sympathectomy
Ginkgo Biloba
Hypothyroidism
Medications
Nerve Blocks
Nitroglycerine Cream
Serotonin Reuptake Inhibitors (SSRI)
Statins
Ineffective Treatments
Research & Clinical Trials
References

Video Overview by Amanda Thorpe


Raynaud's Treatments
in Systemic Scleroderma
Presented by Amanda Thorpe

Mild cases of Raynaud's do not require treatment. Severe attacks which do not respond to the usual treatments, medications, and rewarming procedures may require hospitalization. (Also see: What is Scleroderma?, Types of Scleroderma and Systemic Symptoms)

Overview of Raynaud's Treatments

Diet, lifestyle and smoking can play a significant role in either worsening, or improving, Raynaud's. (Also see: What is Raynaud's?, What is Scleroderma?, and Raynaud's Prevention)
How is Raynaud's Disease Treated? There is no cure for primary or secondary Raynaud's, but many measures can reduce the number or intensity of attacks,. National Heart Lung and Blood Institute.

Mild Cases do not Require Treatment

Raynaud's is often mild and does not require treatment other than prevention techniques. However, various treatments can be used or medications prescribed when there are digital (finger or toe) ulcers, or when Raynaud's becomes painful.

Amputation (Severe Cases)

Sometimes, despite the best efforts by both the doctor and the patient, the Raynaud's in scleroderma may progress to gangrene. In severe cases this may require amputation of the affected part.
Amputation: ISN Photo Repository ISN.
Amputation Links. Charles Eaton, MD.

Biofeedback

Biofeedback is generally not as effective for Scleroderma-related Raynaud's as it can be for primary Raynaud's, although some patients do find it to be helpful.
Effect of biofeedback and deep oscillation on Raynaud's phenomenon secondary to systemic sclerosis: results of a controlled prospective randomized clinical trial. The study underlines the beneficial role of physiotherapy for the treatment of secondary to systemic sclerosis (SSc)–related RP. Birte Sporbeck, Rheumatology International, 18 February 2011. (Also see: Raynaud's Treatments)

Botox

Botox and Raynaud's. For Raynaud's the theory is that it may provide the benefit of a digital sympathectomy operation (that you may be more familiar with) but without surgery. Raynaud's and Scleroderma Association.

Dietary, Lifestyle and Smoking

See Raynaud's Prevention. ISN.

Digital Sympathectomy (Microvascular Hand Surgery) for Severe Cases

Severe cases of Raynaud's should be managed by the rheumatologist, where treatments may include vascular and hand surgery.
thumb-digital-ulcerPhotos of Digital Sympathectomy in Systemic Scleroderma Patient. Click on images to enlarge and for patient commentary from the International Scleroderma Network (ISN) Photo Repository. ISN.
Ulnar artery occlusion is predictive of digital ulcers in SSc: a duplex sonography study. Ulnar artery occlusion is frequent and an important risk factor for the development of digital ulcers in patients with systemic sclerosis. Rheumatology (2012) 51 (4): 735-742. (Also see: Digital Ulcers and What is Scleroderma?)
Digital (Finger) Ulcers. Systemic scleroderma and Raynaud's can cause painful ulcers on the fingers or toes, which are known as digital ulcers. ISN.
Judy King: CREST Syndrome A neurosurgeon performed a Digital Sympathectomy on my right hand and, thank God, my finger was saved...

Ginkgo Biloba

Ginkgo and Raynaud's. Ginkgo reduced the daily frequency of Raynaud's symptoms and that weekly attacks were less frequent. Ginkgo can interact with certain herbs and medications and can increase your risk of bleeding. Raynaud's Association.

Hypothyroidism: Treat, If Necessary

Hypothyroidism occurs in a fair percentage of Scleroderma patients, and adequate treatment for it can be beneficial for the Raynaud's, also. ISN.

Medications for Raynaud's

Medications. There are a number of prescription medications that have been proven to be effective for Raynaud's. ISN.
Mild Cases do not need Treatment
ACE Inhibitors
Alpha-adrenergic Blockers or Blood Thinners
Angiotensin II Antagonist
Bosentan
Estrogen
Calcium Channel Blockers
Iloprost and Alprostadil
Immunosuppressants
N-Acetylcysteine
Nitroglycerine Cream
Prostaglandin
Serotonin Reuptake Inhibitors (SSRI)
Sildenafil Citrate (Viagra, Revatio)

Nerve Blocks

Nerve blocks can help in the short-term, however they frequently worsen Raynaud's in the long run. (2)

Nitroglycerine Cream

Nitroglycerine cream may be used for Raynaud's, although it needs to be used sparingly.

Statins

A 2009 study reported that statins may be beneficial in treating vascular manifestations of systemic sclerosis, such as Raynaud's, through their pleiotropic effects.

Serotonin Reuptake Inhibitors (SSRI)

Treatments for Raynaud's. Serotonin re-uptake antagonists are also used to treat depression. Raynaud's and Scleroderma Association.

Ineffective Treatments for Raynaud's

A 2009 study reported that Tadalafil appears to be safe and well tolerated but wasn't any better than placebo.
A 2005 study showed that vitamin E did not improve perfusion in systemic sclerosis patients.

References

(1) "The Raynaud's phenomenon (RP) treatment study (RTS): A comparison of pharmacologic and behavioral interventions." ACR Abstract.
 
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