AB0713 Botulinum Toxin-A for the Treatment of Severe Raynaud's Phenomenon

Abstract

BackgroundRaynaud's phenomenon (RP) is characterized by transient episodes of vasoconstriction of the arteries and arterioles of the extremities in response to cold or emotional stimuli. Depending on the severity of the vascular insult, it can cause superficial ulceration or deep-tissue necrosis. Pharmacological treatments aim to enhance blood flow but their efficacy is not uniform.ObjectivesTo evaluate the efficacy of botulinum toxin-A in the treatment of severe RP.MethodsWe present a series of 7 patients with RP with bad response to conventional pharmacological therapy that have been treated with local botulinum neurotoxin-A. Exclusion criteria included botulinum toxin allergy, active infection at the site of injection, previous digital sympathectomy and pregnancy.4 to 8 units of botulinum toxin-A were administered per point of injection depending on the degree of severity. Points of injection were located on the lateral and medial aspect of the base of the fingers, except the thumb. Prior to infiltration, obstructive pathology was ruled out by Doppler ultrasound; also, a nailfold capillaroscopy test was performed before and after the infiltration. Variables such as the number of episodes per day, pain during the episodes, recuperation time, finger color and presence of digital ulceration or necrosis have been studied baseline, 30 minutes, one week and one month after the infiltration.Follow up of 6 patients was performed with a 9 weeks median, being 18 weeks the maximum time registered. Patient 1 died due to a peritonitis 3 days after the study started.Results30 minutes after infiltration, three patients felt no improvement, two assessed slight improvement and two very important improvement. At the patients' one-week and thirty-days follow-up visits two patients did not perceive any change and four experienced great amelioration. Patients that did not register any change where those with fewer subjective clinical complaints and normal Doppler ultrasound and capillaroscopy tests.The variable with the most remarkable response was pain, with important pain decrease in all of the cases. Three patients presented digit ulcers at baseline visit; ulceration healing was noted in all of them, two of them one week after the injection and the other one, one month after.Three patients reported mild “weakness” after being injected and one reported slight thenar-eminence pain that lasted a few days. None of the patients suffered any systemic complications related to the toxin.ConclusionsBotulinum toxin-A is a safe and effective therapeutic option for patients with severe RP that have failed to conventional treatment.Disclosure of InterestNone declared

Botulinum Toxins for the Treatment of Raynaud Phenomenon

“…For example, the injection position of Btx varies across studies, including digital, 21,22 palm, 10,23,24 dorsal web spaces, 25 or base of fingers. 26 Moreover, the feasibility of Btx treatment could be a concern, as Kassamali et al 27 suggested, and Btx therapy could not be available for patients with public insurance. Thus, this study aimed to conduct a comprehensive meta-analysis and provide an updated review to further explore the efficacy and injection technique of Btx treatment in patients with RP.…”

“…Nonetheless, despite the clinical effectiveness shown in the current literature, 18–20 Btx treatment is still premature, and the evidence needs further validation. For example, the injection position of Btx varies across studies, including digital, 21,22 palm, 10,23,24 dorsal web spaces, 25 or base of fingers 26 . Moreover, the feasibility of Btx treatment could be a concern, as Kassamali et al 27 suggested, and Btx therapy could not be available for patients with public insurance.…”