Management of Raynaud’s Phenomenon and Digital Ulcers

Abstract

This review describes the principles of approach to, and management of, the patient with Raynaud's phenomenon (RP). The first step is to establish whether RP is primary or secondary to an underlying cause. If RP is secondary, then this has implications for management: the cause may be treatable, and the RP is likely to be more severe than primary RP. If RP is secondary to systemic sclerosis (the type of RP which has been most researched), then the patient will have structural as well as functional vascular changes which may progress to digital ulceration and critical ischemia. Triggering factors should be avoided, and therefore, patient education is an important part of management. The approach to drug treatment is described for patients with mild, moderate and severe RP (severe meaning complicated by the development of digital ulcers or critical ischemia). Surgical interventions are briefly described, bearing in mind that only a minority of patients require surgery. The final section of the review discusses novel (possible future) therapies. Opinion statement Raynaud's phenomenon (RP) is the clinical manifestation of disrupted regulation of the peripheral vasculature that is critical for tissue nutrition and body thermoregulation. While not all patients develop ulceration or critical ischemia, managing RP is most important to improve quality of life (QOL) and prevent secondary complications. Non-drug therapy should be used in every case including cold avoidance, elimination of