Management of Raynaud's phenomenon and digital ulcers in systemic sclerosis

Joint Bone Spine. 2011 Jul;78(4):341-6. doi: 10.1016/j.jbspin.2010.11.005. Epub 2010 Dec 22.

Abstract

Raynaud's phenomenon (RP) and digital ulcers (DU) are the clinical manifestations of vasculopathy in systemic sclerosis. Both interfere with hand function and hold the possibility of severe complications, thus adversely influencing patients' quality of life. Managing RP and DU is often a challenge for the treating physician, who has to establish a treatment plan based upon knowledge of the current therapeutic options. The first step is to differentiate primary from secondary RP, where combining history and physical examination with diagnostic modalities, such as nailfold capillaroscopy, aids in reaching the correct diagnosis. Next a wide range of treatment options is offered nowadays, starting from first-line agents, as calcium channel blockers, to the more targeted-ones, like endothelin receptor antagonists. Research and clinical experience with each agent are reviewed in the text, as well as the combinations that more recently gain field in the treatment of DU.

Publication types

  • Review

MeSH terms

  • Bosentan
  • Calcium Channel Blockers / therapeutic use
  • Cardiovascular Agents / therapeutic use*
  • Endothelin Receptor Antagonists
  • Enzyme Inhibitors / therapeutic use
  • Fingers
  • Humans
  • Phosphodiesterase 5 Inhibitors / therapeutic use
  • Prostaglandins I / therapeutic use
  • Raynaud Disease / drug therapy*
  • Raynaud Disease / etiology
  • Raynaud Disease / physiopathology
  • Scleroderma, Systemic / complications
  • Scleroderma, Systemic / drug therapy*
  • Scleroderma, Systemic / physiopathology
  • Skin Ulcer / drug therapy*
  • Skin Ulcer / etiology
  • Skin Ulcer / physiopathology
  • Sulfonamides / therapeutic use
  • Vasodilator Agents / therapeutic use

Substances

  • Calcium Channel Blockers
  • Cardiovascular Agents
  • Endothelin Receptor Antagonists
  • Enzyme Inhibitors
  • Phosphodiesterase 5 Inhibitors
  • Prostaglandins I
  • Sulfonamides
  • Vasodilator Agents
  • Bosentan