How is Raynauds phenomenon treated? How are digital ulcers treated?
Raynaud’s phenomenon in SSc can be a challenge to effectively manage, but not all patients require specific medical therapy. Here are some general management principles:
• First, keep hands and body warm. Many patients carry gloves at all times. When going to cold places, patients may bring exothermic reaction bags (chemical heat packs), which can be obtained at sporting goods, hardware, and other stores. Repeated soaking in warm water sometimes helps.
• Cigarette smoking exacerbates Raynaud’s phenomenon and should be avoided.
• Various prescription vasodilators can be used in the treatment of secondary Raynaud’s phenomenon associated with SSc, including calcium-channel blockers (first-line therapy), angiotensin-receptor blockers, antiadrenergic agents (e.g., prazosin), topical nitrates, phosphodiesterase type-5 inhibitors (sildenafil), and prostacyclin analogs. In addition, endothelin antagonists may be helpful in some patients (see Chapter 74 : Raynaud’s phenomenon for examples of common dosing regimens and approach to treatment strategies).
• Antiplatelet therapy, anticoagulation, statin medications, and fluoxetine all have evidence of benefit in the treatment of Raynaud’s (see Chapter 74 : Raynaud’s Phenomenon).
• Digital ulcers occur in 30% to 40% patients. All the therapies listed earlier have been used in an attempt to accelerate healing and prevent recurrence, with varying levels of success. Bosentan has been shown to reduce the likelihood of new digital ulcer formation.
• For cases of digit-threatening ischemia, intravenous prostacyclin can be instituted.
• Alternative modalities that can be tried in refractory cases include localized botox injections, digital sympathectomy, and hyperbaric oxygen treatment to expedite digital ulcer healing.
