Raynaud's Phenomenon in Systemic Sclerosis When PDE5 Inhibitors Have Not Worked
This protocol applies to patients with Raynaud's phenomenon occurring in the setting of systemic sclerosis (SSc-RP) whose condition has not been adequately controlled on PDE5 inhibitor therapy and who require escalation to a next-line approach.
Clinical scenario: Raynaud's phenomenon in systemic sclerosis is a vasospastic complication that can persist or worsen despite initial oral therapies. When vasospastic attacks remain frequent, prolonged, or severe, escalation beyond oral agents is indicated.
Prior line — insufficient response
The preceding treatment used PDE5 inhibitors. This protocol is indicated when that regimen fails to achieve a meaningful improvement in the Raynaud's condition score or to produce adequate reduction in the daily frequency and duration of Raynaud's phenomenon attacks.
Next-line approach — partial overview
For severe SSc-RP that has not responded to oral therapy, the next step involves an intravenous prostanoid. The full structured regimen — including patient selection, monitoring, and the complete evidence-based algorithm — is accessible via the protocol below.
Dosing, sequencing, and full regimen details are not shown here — access the complete protocol below.
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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