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

Secondary Raynaud's phenomenon progresses to tissue damage — digital ulceration and critical digital ischaemia — when it occurs in the context of an underlying connective tissue disease. This scenario requires a specific, structured approach that differs from primary Raynaud's management.

Clinical scenario: Raynaud's phenomenon secondary to connective tissue disease, presenting with digital ulceration or critical digital ischaemia. The management principles for both complications are closely aligned and are addressed within a unified structured framework.

Treatment goal

Reduction in the number of new digital ulcers — preventing further tissue damage is the primary measurable objective in this setting.

Approach overview

A licensed therapy targeting the prevention of recurrent digital ulcer formation is central to the structured regimen for this connective-tissue-disease complication. Full selection criteria, monitoring parameters, and the complete regimen are in the protocol below.

Instant Access to Structured Evidence-Based Regimens

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.
Bosentan is licenced for the prevention of recurrent digital ulcers in patients with SSc.
It has been shown in two multicentre RCTs, comparing bosentan with placebo, to reduce the number of new ulcers, although there was no effect on the healing of existing ulcers.

DOI: 10.1177/1759720X17740074

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