| RAYNAUD'S: MAIN MENU |
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Raynaud's Treatments |
| This page was written by Shelley Ensz, and has not yet been medically edited. See Disclaimer. |
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| 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. |
| The efficacy of complementary and alternative medicine (CAM) in the treatment of Raynaud's phenomenon (RP): a literature review and meta. There is a need for well-designed trials of CAM in RP. Biofeedback does not work for RP, therapeutic gloves may improve RP. Laser may be effective but the improvement may not be clinically relevant. D. Malenfant. Rheumatology Advance Access. May 11 2009. |
| 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 |
| Botulinum Toxin Type A (BTX-A): A Treatment Option for Digital Ischemia in Patients With Raynaud's Phenomenon. BTX-A was found to be a safe and useful treatment option for vasospastic digital ischemia. (Unbound Medline) A. Fregene. J Hand Surg. March 2009. (Also see: Digital Ulcers) |
| 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. |
| Ulnar artery vasculopathy in systemic sclerosis. It is suggested that angiographic screening and early surgical intervention such as revascularization should be considered in patients with systemic sclerosis who manifest a severe form of Raynaud’s phenomenon and/or digital ulceration and especially in patients with diffuse sclerosis. Jeong Ha Park. Rheumatology International. April 12, 2009. (Also see: Digital Ulcers) |
| 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) |
| 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. |
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| 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 |
| Long-term beneficial effects of statins on vascular manifestations in patients with systemic sclerosis. This pilot study suggests that statins may be beneficial in treating vascular manifestations of SSc, such as Raynaud’s, through their pleiotropic effects. However, this treatment did not correct the defect in endothelial progenitor cells recruitment. Masataka Kuwana. (SpringerLink) Modern Rheumatology July 10, 2009. (Also see: Vascular Involvement and Statins) |
| Statins: Potentially Useful in Therapy of Systemic Sclerosis-related Raynaud's Phenomenon (RP) and Digital Ulcers (DU) . Our results showed that statins retarded vascular injury and improved patient function. The findings suggest that statins may aid in treating RP and DU in SSc patients. A. Abou-Raya. Journal of Rheumatology. August 15, 2008. (Also see: Statins and Digital Ulcers) |
| 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 |
| Randomized Placebo-Controlled Crossover Trial of Tadalafil in Raynaud's Phenomenon (RP) Secondary to Systemic Sclerosis (SSc). Tadalafil appears to be safe and well tolerated but lacks efficacy in comparison to placebo as a treatment for RP secondary to SSc. Elena Schiopu. JRheum. September 15, 2009 36 (9). |
| 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. |
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