title: Contemporary management of Raynaud's phenomenon and digital ischaemic complications.
abstract: OBJECTIVE
  The present review gives an update of the current management of Raynaud's phenomenon and its ischaemic complications (digital ulceration and critical ischaemia) and discusses possible further developments in the next 5-10 years. New approaches to therapy are being driven by increased understanding of pathophysiology and by increased international networking of clinicians and scientists, facilitating clinical trials.
  
  
  RESULTS
  Key points include phosphodiesterase inhibitors most likely confer benefit, although clinical trials have given somewhat conflicting results, and have been short-term; a new topical, easy-to-use glyceryl trinitrate preparation has been shown to improve Raynaud's Condition Score; the endothelin-1 receptor antagonist bosentan has now been shown to reduce the number of new systemic sclerosis (SSc)-related digital ulcers in two multinational clinical trials; and although statin therapy is likely to confer benefit in SSc-related Raynaud's phenomenon, further research is required to confirm this.
  
  
  CONCLUSIONS
  New therapeutic approaches in patients who do not respond to more traditionally used vasodilators include phosphodiesterase inhibitors and (for those with recurrent SSc-related digital ulcers) endothelin-1 receptor antagonism. Several other potential new therapies are being researched. Optimal management of digital ulceration is multidisciplinary including tissue viability and (sometimes) surgical input.
authors: The University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK. ariane.herrick@manchester.ac.uk
authors: Ariane L
authors: AL
authors: Herrick
mesh_terms: D000975:Antioxidants / Q000627:therapeutic use; D001120:Arginine / Q000378:metabolism; D065130:Endothelin A Receptor Antagonists; D005385:Fingers / Q000098:blood supply; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D007511:Ischemia / Q000209:etiology* / Q000628:therapy*; D009569:Nitric Oxide / Q000378:metabolism; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011928:Raynaud Disease / Q000150:complications* / Q000378:metabolism / Q000628:therapy*; D015398:Signal Transduction; D012883:Skin Ulcer / Q000209:etiology* / Q000628:therapy*; D014034:Toes / Q000098:blood supply
chemical_list: D000975:Antioxidants; D065130:Endothelin A Receptor Antagonists; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors; D009569:Nitric Oxide; D001120:Arginine