Raynauds phenomenon, treatment options and related disease

[Mike Bartolatz]

A Member of the Uveitis support group who suffers from Raynaud's and who is also a Nurse Practioner posted this and I thought I would share it here so that others can use the information.

wish all the very best,
Mike Bartolatz

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Raynaud's: treatment options
Posted: 11/5/06 8:02 am
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Cathy's posts sparked a little research on treatment modalities available for Raynaud's. Since many of us experience this as part of an autoimmune syndrome, I thought it might be of interest. I have the citations if anyone wants them.

Definition: Exaggerated vascular response to cold temperature or emotional stress. It is manifested clinically by sharply demarcated color changes of the skin of the digits. "Primary" RP = without associated illness. "Secondary" RP = in associated with related illness, such as SLE or scleroderma.

Secondary RP is more likely to lead to severe vasoconstriction, resulting in ulceration, pain, loss of blood supply to digits.

Non-drug therapy:
++ avoid sudden cold exposure
++ minimize stress
++ keep whole body warm
++ keep digits warm (mittens, hand warmers)
++ to terminate an attack: place hands under warm water or in armpits, or rotate arms in windmill pattern
++ avoid rapidly changing temps
++ avoid smoking
++ avoid econgestants, amphetamines, diet pills, ephedra
++ behavioral therapies: biofeedback, autogenic training, conditioning, are safe and often effective, particularly for primary RP. Patients have been shown to be able to control the temperature and constriction/dilation of the blood vessels in their extremities.

Drug therapy:
++ calcium channel blockers helpful for both primary and secondary RP. Nifedipine, amlodipine, diltiazem, felodipine, nisoldipine, isradipine are specified.
Long acting nifedipine was effective yielded a 66% reduction of attacks in a study of patients with primary RP. Patents with secondary RP are less likely to benefit.
++ Secondary RP: need more aggressive tx with "vasoactive drugs" which cause dilation of the small blood vessels affected by RP. This includes nitrates (topical nitroglycerin), prazosin (vasodilator), angiotensin receptor blockers (losartan), sildenafil (Viagra), pentoxifylline, cilostazol, bosentan, antidepressants such as prozac, and prostaglandins.

Diseases asso. with RP:
scleroderms
SLE
dermatomyositis, polymyositis
RA
arteritis
primary biliary cirrhosis

Injury:
vibration
frost bite

Recurrent trauma or large vessel compromise:
crutch pressure
thoracic outlet syndrome

Arterial disease
Vasospastic disorders (migraine or vascular headaches, prinzmetal angina)

endocrine disorders: carcinoid syndrome, pheochromocytoma, hypothyroidism

malignancy: ovarian cancer, lymphoma

Blood abnormalities (such as polycythemia)
Infections (H. Pylori, Fifth's disease)
Chemicals/drugs: various chemotherapies, beta blockers, ergots, interferon

I hope this was helpful.
Jordan