In secondary Raynaud's phenomenon, tissue damage in the form of digital ulceration or critical digital ischaemia occurs specifically in the setting of an underlying connective tissue disease. When an initial oral therapy has not achieved the primary goal of ulcer healing, a structured next-line approach is indicated.
Secondary Raynaud's phenomenon progresses to tissue damage — digital ulceration and critical digital ischaemia — when it is driven by an underlying connective tissue disease. These two complications share the same management principles and are addressed together in this protocol.
This protocol applies when Sildenafil has been used and the primary target of digital ulcer healing has not been achieved. Failure to reach this goal is the trigger for escalation to the next treatment line.
The next step involves an intravenous prostanoid therapy administered on a structured schedule. The full regimen, decision pathway, and frequency parameters are available via the complete protocol.
Digital ulcer healing; reduction in the frequency and severity of Raynaud's phenomenon attacks.
DOI: 10.1177/1759720X17740074
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.
Intravenous prostanoid (usually iloprost) up to a frequency of every 6-8 weeks if necessary.
Intravenous prostanoids reduce frequency and severity of RP attacks and heal digital ulcers.
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