Treatment options in Raynaud's phenomenon

Abstract

Introduction: Raynaud's phenomenon (RP) is an exaggerated color change of the extremities in response to cold ambient environments and/or emotional stressors. RP may be primary (idiopathic) or secondary to an underlying cause, for example, systemic sclerosis (SSc). An increasing understanding of the pathogenesis of RP is driving the development of new therapeutics and the re-examination of past treatments: several multicenter clinical trials have been conducted in recent years.

Areas covered: The aim of this review is to provide the readers with the background to understand the rationale for the current treatments used in patients with RP, to critically appraise the evidence for these treatments and to discuss future treatment approaches. A literature review was undertaken (including publications up to October 2013) using MedLine for English-language papers.

Expert opinion: Calcium channel blockers are first-line treatment. A number of other treatment options have been investigated. New treatment options include phosphodiesterase inhibitors and (for SSc-related digital ulceration) endothelin-1 receptor antagonists. There are recurrent methodological concerns in previous clinical trials which should be addressed in designing future clinical trials. Key questions remaining include the role of statins, antioxidants, antiplatelet therapy and anticoagulation in patients with RP, especially SSc-related RP.

Keywords::

• clinical trials
• critical ischemia
• digital ischemia
• digital ulcers
• nailfold capillaroscopy
• Raynaud's phenomenon
• systemic sclerosis
• treatment

Notes

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