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Pharmacotherapy Options in the Management of Raynaud's Phenomenon.
Curr Treatm Opt Rheumatol 2018; 4(3):235-254CT

Abstract

Purpose of review

Multiple classes of medications have been studied for the treatment of Raynaud's phenomenon (RP) with or without digital ischemia. The goal of this review is to discuss the outcomes of recent studies and to report on our approach to the management of RP in light of the available evidence.

Recent findings

Comparing treatments for RP remains a challenge as efficacy endpoint vary widely among trials. While calcium channel blockers are used first-line in the pharmacologic management of RP, phosphodiesterase 5 inhibitors have also been shown to be beneficial in reducing symptoms. In the setting of digital ischemia, administration of intravenous prostanoids is the standard of care. Bosentan has shown benefit in the prevention of future ulcers in patients with scleroderma. Botulinum toxin therapy was ineffective in a clinical trial involving scleroderma patients; more controlled studies are needed in other subsets of patients. Digital sympathectomy may be beneficial in cases of critical digital ischemia, though recurrence of symptoms is common.

Summary

Comparative effectiveness studies are needed to determine which therapeutic interventions are most beneficial in patients with RP. Based on the available evidence, we start with CCBs and add a phosphodiesterase inhibitor if symptoms are not controlled, or intravenous prostacyclin in the setting of severe critical digital ischemia. We may additionally add an endothelial receptor antagonist in cases of recurrent digital ulcers. A surgical sympathectomy may be used in refractory cases of digital ischemia. A digital block may also be a less invasive, but temporary, intervention allowing for titration of medical therapy.

Authors+Show Affiliations

Division of Rheumatology, Johns Hopkins University, 5200 Eastern Avenue, MFL Building, Center Tower Ste. 4100, Baltimore, MD, 21224.Division of Rheumatology, Johns Hopkins University, 5200 Eastern Avenue, MFL Building, Center Tower Ste. 4100, Baltimore, MD, 21224.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31538045

Citation

Hinze, Alicia M., and Fredrick M. Wigley. "Pharmacotherapy Options in the Management of Raynaud's Phenomenon." Current Treatment Options in Rheumatology, vol. 4, no. 3, 2018, pp. 235-254.
Hinze AM, Wigley FM. Pharmacotherapy Options in the Management of Raynaud's Phenomenon. Curr Treatm Opt Rheumatol. 2018;4(3):235-254.
Hinze, A. M., & Wigley, F. M. (2018). Pharmacotherapy Options in the Management of Raynaud's Phenomenon. Current Treatment Options in Rheumatology, 4(3), pp. 235-254. doi:10.1007/s40674-018-0102-6.
Hinze AM, Wigley FM. Pharmacotherapy Options in the Management of Raynaud's Phenomenon. Curr Treatm Opt Rheumatol. 2018;4(3):235-254. PubMed PMID: 31538045.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pharmacotherapy Options in the Management of Raynaud's Phenomenon. AU - Hinze,Alicia M, AU - Wigley,Fredrick M, Y1 - 2018/07/04/ PY - 2019/9/21/entrez PY - 2019/9/21/pubmed PY - 2019/9/21/medline KW - Raynaud’s KW - outcomes KW - procedures KW - review KW - scleroderma KW - treatment SP - 235 EP - 254 JF - Current treatment options in rheumatology JO - Curr Treatm Opt Rheumatol VL - 4 IS - 3 N2 - Purpose of review: Multiple classes of medications have been studied for the treatment of Raynaud's phenomenon (RP) with or without digital ischemia. The goal of this review is to discuss the outcomes of recent studies and to report on our approach to the management of RP in light of the available evidence. Recent findings: Comparing treatments for RP remains a challenge as efficacy endpoint vary widely among trials. While calcium channel blockers are used first-line in the pharmacologic management of RP, phosphodiesterase 5 inhibitors have also been shown to be beneficial in reducing symptoms. In the setting of digital ischemia, administration of intravenous prostanoids is the standard of care. Bosentan has shown benefit in the prevention of future ulcers in patients with scleroderma. Botulinum toxin therapy was ineffective in a clinical trial involving scleroderma patients; more controlled studies are needed in other subsets of patients. Digital sympathectomy may be beneficial in cases of critical digital ischemia, though recurrence of symptoms is common. Summary: Comparative effectiveness studies are needed to determine which therapeutic interventions are most beneficial in patients with RP. Based on the available evidence, we start with CCBs and add a phosphodiesterase inhibitor if symptoms are not controlled, or intravenous prostacyclin in the setting of severe critical digital ischemia. We may additionally add an endothelial receptor antagonist in cases of recurrent digital ulcers. A surgical sympathectomy may be used in refractory cases of digital ischemia. A digital block may also be a less invasive, but temporary, intervention allowing for titration of medical therapy. SN - 2198-6002 UR - https://www.unboundmedicine.com/medline/citation/31538045/Pharmacotherapy_Options_in_the_Management_of_Raynaud's_Phenomenon L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/31538045/ DB - PRIME DP - Unbound Medicine ER -