Pharmacologic treatment in Raynaud phenomenon

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

When to introduce pharmacotherapy in patients with Raynaud phenomenon?

When Raynaud is frequent, >5 attacks a week, and it’s debilitating, so, for example, you can’t do up your buttons, those would be the indications in primary Raynaud to treat with medications.

In secondary Raynaud we’re always anxious about end organ disease, damage, such as digital ulcers, calcinosis, gangrene. We would be very vigorously treating those cases. I tend to start with one medication and build upon that week by week, month by month, if necessary.

Of course, if somebody is developing gangrene as a complication, that’s a warrant for hospital admission because it’s limb threatening. You can lose a finger. We really have to work quickly and work with our internal medicine colleagues on that.