| RAYNAUD'S:
MAIN MENU |
|
| Raynaud's
Treatments |
| This
page was written by Shelley
Ensz, and has not yet been medically edited. See Disclaimer. |
|
| 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.
Severe attacks which do not respond to the usual treatments, medications,
and rewarming procedures may require hospitalization. |
| 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. |
| Raynaud's
phenomenon in dermatology: Part 2: Therapy. While
primary Raynaud's phenomenon (RP) only rarely leads
to complications, secondary RP when associated with
systemic sclerosis frequently results in necrosis,
ulcers or even gangrene. Therefore timely therapeutic
intervention is required. PubMed. Hautarzt. 2006
Oct;57(10):927-942. |
| Raynaud's
Phenomenon in Mixed Connective Tissue Disease. The
goal in the therapy of Raynaud's phenomenon in MCTD
is to decrease the frequency of attacks, prevent digital
ulceration, and limit progressive vascular damage. PubMed.
Rheum Dis Clin North Am. 2005 Aug;31(3):465-81. (Also
see: MCTD) |
| 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. |
| Biofeedback Helps Alleviate Raynaud's Disease Symptoms. Biofeedback is a mind-body technique using electronic instruments to help individuals gain awareness and control over their body and mind. Medical News Today. 01/12/08. |
| Botox |
| Botox May Improve Blood Flow in Raynaud's. Botox (botulinum toxin type A), sharply reduced pain, improved blood flow, and fostered healing of ischemic fingertip ulcerations in every patient Dr. Neumeister has treated (16 to date). Rheumatology News. Vol 7, Issue 2, P5 (Feb 2008) |
| Raynaud's
Phenomenon: Treatment with Botulinum Toxin. We
used Botulinum toxin A to paralyse the muscles of digital
arteries – thus inhibiting vasoconstriction. All but
one patient reported a relief of symptoms. The subjective
improvement of cold-induced pain warrants further investigations
of BTX-A for RP. E. Stadlmaier. FRI0060 EULAR 2005. |
| 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. |
| Wound healing after hand surgery in patients with systemic sclerosis-a retrospective analysis of 41 operations in 19 patients. In systemic sclerosis, surgery performed electively does not seem to have increased difficulty with wound healing. Even larger operations, such as wrist arthrodesis or wrist replacement, can be performed safely.PubMed. J Hand Surg [Br]. 2007 Feb 1. (Also see: Digital Ulcers) |
| Surgery
of the hand in patients with systemic sclerosis: outcomes
and considerations. The goals of surgery for advanced
SSc affecting the hand are limited and include pain
relief through sympathectomy and increased perfusion,
repositioning the digit, providing a functional position
of fusion, and modest mobilization through resection
arthroplasty. J Rheumatol. 2005 Apr;32(4):642-8.
(Also see: Sclerodactyly, Skeletal
Involvement, and Calcinosis) |
| Periarterial
Sympathectomy as a Salvage Procedure for Refractory
Digital Ischemia in Scleroderma Patients. Periarterial
Sympathectomy is an effective salvage procedure in
scleroderma patients with refractory digital ischemia
and fingertip ulcerations. The procedure should be
considered in patients who fail medical management. Nadera
J. Sweiss. ACR Conference Oct. 2003. (Also see: Digital
Ulcers) |
| Continuous
regional anesthesia before surgical peripheral sympathectomy
in a patient with severe digital necrosis associated
with Raynaud's phenomenon and scleroderma. Continuous
ambulatory regional anesthesia appears effective as
a treatment bridge for vasospasm and ischemia associated
with secondary Raynaud's phenomenon. PubMed. Reg
Anesth Pain Med. 2003 Jul-Aug;28(4):354-8. (Also see:Digital
Ulcers) |
| See also: Digital
(Finger) 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
Biloba. The World Health Organization has recommended
the use of ginkgo in Raynaud's disease, acrocyanosis,
and post-phlebitic syndrome. American Family Physician,
Sept. 1, 2003. |
| 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. |
| Laser Therapy
for Raynaud's |
| Low
Level Laser Therapy in Primary Raynaud's Phenomenon
— Results of a Placebo Controlled, Double Blind Intervention
Study. Low level laser therapy reduces frequency
and severity of Raynaud attacks. The effect is most
pronounced in patients with signs of decreased threshold
for vasospasm and less effective in patients with delayed
hyperemia. J Rheumatol. December 2004;31:2408-12. |
| Low
level laser therapy for treatment of primary and secondary
Raynaud's phenomenon. Since this therapeutic modality
is a safe, and non-invasive treatment, it might be
considered as an alternative to existing therapeutic
regimes. PubMed. Vasa. 2004 Feb;33(1):25-9. |
| Medications for Raynaud's |
| Medications. There are a number of prescription medications that have been proven to be effective for Raynaud's. ISN |
|
|
| 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. |
| A Multi-Center Placebo-Controlled “In-Life” Study of MQX-503 in Patients with Raynaud Phenomenon (RP). MQX-503 (a novel formulation of topical nitroglycerin gel) is well-tolerated and more effective than placebo in the treatment of RP, with more pronounced effects during the winter season and in patients with primary disease. L. Chung. 2163/21. ACR 2007. |
| The Topical Application Of Nitroglicerin Cream Improves Raynaud Phenomenon (RP) At Hands In Systemic Sclerosis Patients: A Pilot, Open Label Study. Our data show that nitroglicerin cream is safe, reduces the intensity and the frequency of RP attacks. Effects are rapid and long lasting. Although the results should be confirmed on wider groups of patients, nitroglicerin cream might be considered as an alternative topical therapy for RP. G. Fiori. AB0503 EULAR 2007. |
| Statins |
| Simvastatin Reduces Endothelial Activation and Damage But Is Partially Ineffective in Inducing Endothelial Repair in Systemic Sclerosis (SSc). Treatment with simvastatin results in rapid and significant improvement of measures of endothelial activation, suggesting a potential role of statins in the treatment of peripheral vascular disease in SSc. Journal of Rheumatology. June 2008. (Also see: Medications, and Causes of Scleroderma: Endothelin) |
| Serotonin Reuptake
Inhibitors (SSRI) |
| Raynaud's
Phenomenon and Serotonin Reuptake Inhibitors. The
antiplatelet and endothelium-protective properties
of SSRI (selective serotonin reuptake inhibitors) may
represent an attractive additional advantage in patients
with depression and scleroderma. Patients who have
scleroderma should be screened for depression, and
SSRI might be considered when indicated. Correspondence.
J Rheumatol. VOLUME 31: NO. 10 OCTOBER 2004. (Also
see: Scleroderma
and Depression) |
| Ineffective
Treatments for Raynaud's: Vitamin E |
| Vitamin
E: Effects of short-term treatment with vitamin E in
systemic sclerosis: a double blind, randomized, controlled
clinical trial of efficacy based on urinary isoprostane
measurement. We show that 3-week vitamin E treatment
at doses of 500 or 1000 mg/day neither decreases the
basal rate of lipid peroxidation nor improves microvascular
perfusion after cold exposure. This data does not support
the need for phase III clinical trials to test efficacy
of vitamin E in systemic sclerosis (SSc). PubMed.
Free Radic Biol Med. 2005 Jan 1;38(1):98-103. |
| References |
| (1) "The Raynaud's phenomenon
(RP) treatment study (RTS): A comparison of pharmacologic
and behavioral interventions." ACR Abstract. |
| (2) Dr.
Maureen Mayes, speaking on Raynaud's at the 1998
Scleroderma Conference in Houston, Texas. |
| (3) Article "Unifying
the Scleroderma Front" by Dr. Fredrick M. Wigley
which was posted as a Johns Hopkins Physician Update. |
| (4) Oral Iloprost was proven
ineffective for Raynaud's Phenomenon in Scleroderma: "Oral
iloprost for Raynaud phenomenon (RP) in systemic sclerosis
(SSC): A placebo-controlled, double-blind study" ACR
Abstract. |
| (5) Procardia/Heartburn: "Understanding
Scleroderma" by Dr. Dolores Vázquez-Abad. |
