Treatment of Raynaud's Phenomenon

Non-Pharmacological Management

The American College of Rheumatology recommends that all patients with Raynaud's implement trigger avoidance and lifestyle modifications before or alongside any pharmacotherapy, including cold avoidance, smoking cessation, avoiding triggering medications, stress management, avoiding vibration injury and repetitive hand trauma, and physical therapy 2, 3
Cold avoidance measures, such as wearing proper warm clothing and using hand/foot warmers, can help reduce the frequency and severity of attacks 3, 1
Smoking cessation is mandatory, as smoking directly worsens vasospasm and must be addressed 2, 4
Avoiding triggering medications, such as beta-blockers, ergot alkaloids, bleomycin, and clonidine, is crucial in managing Raynaud's 3, 1
Stress management techniques can help reduce the frequency and severity of attacks, as emotional stress can trigger attacks 3, 4
Avoiding vibration injury and repetitive hand trauma, particularly in occupational settings, is essential in preventing attacks 3, 5
Physical therapy, including exercises to generate heat and stimulate blood flow, can be beneficial in managing Raynaud's 3, 1

The European League Against Rheumatism recommends nifedipine (dihydropyridine-type calcium channel blocker) as the first-line pharmacotherapy for both primary and secondary Raynaud's, reducing both frequency and severity of attacks with acceptable adverse effects and low cost 1, 4
Phosphodiesterase-5 inhibitors, such as sildenafil or tadalafil, can be added or switched to for patients with inadequate response to calcium channel blockers, effectively reducing frequency and severity of Raynaud's attacks 1, 4
Intravenous iloprost (prostacyclin analogue) can be used for severe Raynaud's unresponsive to oral therapies, with proven efficacy for healing digital ulcers 1, 4

The American College of Rheumatology recommends bosentan (endothelin receptor antagonist) for preventing new digital ulcers, particularly in patients with multiple existing ulcers 3, 1
Phosphodiesterase-5 inhibitors can also prevent new digital ulcers and are effective for healing existing digital ulcers 1, 4
Intravenous iloprost is proven to be effective for healing digital ulcers 1, 4

The American College of Rheumatology recommends always evaluating for systemic sclerosis and other connective tissue diseases, as delayed diagnosis leads to digital ulcers and poor outcomes 4, 5
Continuing triggering medications, such as beta-blockers and other vasoconstrictors, will undermine all treatment efforts 1, 4
Delaying escalation in secondary Raynaud's can lead to digital ulcers and poor outcomes, and more aggressive therapy is required 1