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Raynaud's phenomenon - Management
Basis for recommendation

Recommendations are made on the basis of limited expert opinion, feasibility, and what CKS considers to be good clinical practice.

  • An update for GPs written by an expert on behalf of the Raynaud's and Scleroderma Association states that [Raynaud's & Scleroderma Association, 2008]:
    • If secondary Raynaud's phenomenon is suspected, referral to a specialist centre should be made 'if necessary'.
    • 'Investigations can be arranged by the GP, or a referral can be made to a specialist'.
  • Treatments for severe Raynaud's and digital ischaemia can only feasibly be given in secondary care.
    • Intravenous iloprost (a prostaglandin) reduces the frequency and severity of attacks compared with placebo in people with Raynaud's phenomenon secondary to systemic sclerosis [Herrick, 2008a]. It may also be used for acute severe ischaemia with threatened digital loss [Pope, 2007b].
    • Bosentan (a dual endothelin-1 receptor antagonist) may reduce new digital ulcer formation compared with placebo in people with Raynaud's phenomenon secondary to systemic sclerosis (and with previous digital ulcers in the last 12 months) [Herrick, 2008a], but should only be used under specialist supervision [BNF 56, 2008].
    • Surgical interventions include:
      • Digital (palmar) sympathectomy although its role has not been fully established [Herrick, 2008c].
      • Stellate ganglion blocks, lumbar sympathetic blocks, and local or regional sympathectomy may be used for acute severe ischaemia with threatened digital loss [Pope, 2007b].
      • Debridement of infected or necrotic tissue [Herrick, 2008c].

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