Treatment of Secondary Raynaud's Phenomenon with Digital Ulceration or Critical Digital Ischaemia in Connective Tissue Disease

Clinical scenario

Secondary Raynaud's phenomenon (RP) progresses to tissue damage when it arises from an underlying cause — most commonly a connective tissue disease. In this setting, patients may develop digital ulceration or critical digital ischaemia, representing the severe end of the vascular spectrum.

The principles of management are very similar for both digital ulceration and critical ischaemia and are therefore addressed together under this protocol.

Management overview

Management centres on standard medical therapy — including agents from several pharmacological classes — combined with adequate analgesia, which is an essential component of care. Antibiotic treatment is incorporated where infection is suspected or confirmed.

The complete structured regimen — including agent selection, sequencing, and ancillary measures — is available via the full protocol below.

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References

RP only progresses to tissue damage when secondary to an underlying cause, which for the rheumatologists usually means a connective tissue disease.

These principles of management are very similar for both digital ulceration and critical ischaemia, and so will be considered together.

Standard medical therapy (e.g. calcium channel blockers, ACE inhibitors, losartan, fluoxetine).

Adequate analgesia is an essential part of management.

Opioids may be required in the short term.

Antibiotics should be given if there is suspected or definite infection.

DOI: 10.1177/1759720X17740074

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