Raynaud's Phenomenon in Limited Cutaneous Systemic Sclerosis — Next-Line Management After PDE5 Inhibitor Failure

This protocol applies to patients with Raynaud's phenomenon complicating limited cutaneous systemic sclerosis (lcSSc) who have not achieved an adequate response to PDE5 inhibitor therapy.

Clinical Scenario

Raynaud's phenomenon is a recognised manifestation of limited cutaneous systemic sclerosis. When oral therapies — including first-line agents — do not provide sufficient control, a next-line strategy is indicated based on established evidence.

Previous Treatment — Goals Not Met

The prior line used PDE5 inhibitors. Escalation to this protocol is triggered by failure to achieve: improvement in Raynaud's condition score, and meaningful reduction in the daily frequency and duration of Raynaud's phenomenon attacks.

Next-Line Approach

When oral treatment has not produced an adequate response, a specific therapy administered in a clinical setting is considered for severe Raynaud's attacks in this population. The complete regimen — including agent selection, administration details, and monitoring parameters — is available in the structured protocol below.

Instant Access to Structured Evidence-Based Regimens

References

Dihydropyridine-type calcium antagonists, usually oral nifedipine, should be used as first-line therapy for SSc-RP.

Intravenous iloprost should be considered for severe SSc-RP following failure of oral therapy.

DOI: 10.1136/ard-2024-226430

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