RAYNAUD'S PHENOMENON

• A phenomenon of painful pale- or bluish discoloration of the tips of the fingers, toes, nose, etc. thought to be mediated by excessive vasoconstriction, typically triggered by exposure to cold.
• If severe can cause ulceration and tissue loss
• Can be seen in Autoimmune diseases, e.g. scleroderma

In a prospective study of a cohort of 1,358 community-dwelling adults, baseline prevalence of Raynaud's Phenomenon was 11% in women and 8% in men; remission rate over 7y of f/u was 64% (Arth. Rheum. 52:1259, 2005--JW)

Treatments traditionally include cold avoidance, Calcium channel blockers, Angiotensin Receptor Blockers, and topical nitroglycerin, though none of these is highly effective

Digital artery sympathectomy can relieve sx but sx frequently recur

Botox

• Helpful in one uncontrolled study  (Plast. Reconstr. Surg. 119:217, 2007--JW)
• In an uncontrolled study in 19 pts with symptomatic Raynaud phenomenon (14 had fingertip ulcerations), boxot injected at the neurovascular bundle and at the level of the MTP joints, 13 had immediate pain relief and ulcers in 13 pts healed within 2 months.  Pain relief persisted in 12 pts at the last f/u visit @ 13-59mos.  (Plast. Reconstr. Surg. 124:191, 2009-JW)

Bosentan (an endothelin antagonist) for Raynaud's phenomenon

• In a study of 122 pts with digital ulcerations randomized to Bosentan vs. placebo x 16wks, incidence of new ulcers was sig. lower in the Bosentan group (though healing of existing ulcers wasn't sig. diff. between the two groups) (Arth. Rheum. 50:3985, 2004--JW)