Treatment in primary and secondary Raynaud phenomenon

Margaret J. Larché, MD, is a professor of medicine in the Division of Rheumatology at McMaster University and director of the Canadian Scleroderma Research Group (CSRG).

How does the treatment of primary Raynaud phenomenon differ from that in Raynaud phenomenon secondary, for example, to systemic sclerosis?

The treatment really doesn’t change too drastically. What we find, though, in primary Raynaud is that more often than not we do not need medications. We would tend to suggest to the patient to use conservative measures: keeping their hands warm, wearing gloves—including heated gloves and socks; battery-powered heated gloves and socks—avoiding some of the medications that can cause Raynaud.

In primary Raynaud, we often do not need medications. But if the patient has such severe Raynaud that they do need medications, we would start with the ones that we use in secondary [Raynaud phenomenon]. We would start with a calcium channel blocker most commonly and we go to the highest dose that’s effective without too many side effects. Then we would go on to use the phosphodiesterase-5 (PDE5) inhibitors, including sildenafil or tadalafil. There’s good evidence that those reduce the number of Raynaud attacks and reduce the severity and also the possibility of ulceration of the fingertips. Then there are different medications we can use beyond that, if necessary.