Calcium channel blockers for primary and secondary Raynaud's phenomenon

Rirash, Fadumo; Tingey, Paul; Harding, Sarah E; Maxwell, Lara; Ghogomu, Elizabeth Tanjong; Wells, George A.; Tugwell, Peter; Pope, Janet

doi:10.1002/14651858.cd000467.pub2

Cited by 62 publications

(53 citation statements)

References 71 publications

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“…Der Effekt gegenüber Plazebo ist allerdings nicht groß. Die letzte Cochrane-Analyse datiert von 2017 [20], die eingeschlossenen Studien sind aus den 1980er-und 1990er-Jahren. Die Reduktion der Anfallsfrequenz liegt bei 10 -40 %, die Schmerzreduktion ist geringer.…”

Section: Kalziumkanalblockerunclassified

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Raynaud-Phänomen

Caspary¹

2020

Gefäßmedizin Scan - Zeitschrift für Angiologie, Gefäßchirurgie,

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Das Raynaud-Phänomen ist nach Maurice Raynaud (1834-1881) benannt, der in seiner Promotion 1862 erstmals die "lokale Erstickung" der Extremitäten beschrieben hat [1]. Es bezeichnet eine anfallsweise Verfärbung von peripheren Gliedmaßen aufgrund einer passageren Vasospastik. Die Diagnose lässt sich demnach bereits durch eine präzise Anamnese stellen. Im Zweifelsfall kann man den Patienten Bilder mit den typischen Verfärbungen zeigen und sich ein ähnliches Erscheinungsbild bei ihnen bestätigen lassen; oft legen die Patienten selbst Fotos vor, die während der Anfälle aufgenommen wurden (▶ Abb. 1). Die Prävalenz des Phänomens liegt bei 5 % [2], ist aber in warmen Regionen deutlich geringer, in kalten höher [3]. Die klinische Bedeutung der Erscheinungen ist variabel. Eine sozialmedizinische Relevanz haben sie nur bei einem geringen Teil der Betroffenen. Klinik Bei vollständiger Aufhebung der Perfusion durch den im Bereich der Arteriolen lokalisierten Vasospasmus färben sich die abhängigen Partien weiß ("Leichenfinger"). Erlaubt die Vasospastik eine langsame Restperfusion, wird die Hautfarbe aufgrund der weitgehenden Sauerstoffentsättigung des Hämoglobins livide. Die Verfärbungen können isoliert oder nacheinander auftreten. Nach Ende des Raynaud-Anfalls kommt es teilweise zu einer reaktiven Vasodilatation mit Rötung der Haut durch die resultierende Hyperämie. Merke Die Abfolge "Zyanose (blau) → Vasospastik (weiß) → Hyperämie (rot)" wird als "Trikolorephänomen" bezeichnet und gilt als typisch für das Raynaud-Phänomen, ist aber selten vollständig.

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Section: Kalziumkanalblockerunclassified

“…Auch unter Gabe von Statinen wurde eine Besserung von Raynaud-Symptomen berichtet, möglicherweise im Sinne eines pleiotropen Effekts [21]. [20]. Dennoch haben sie einen nachweisbaren Effekt und sind als primäre medikamentöse Therapie empfohlen [23].…”

Section: Weitere Medikamenteunclassified

Raynaud-Phänomen

Caspary¹

2020

Gefäßmedizin Scan - Zeitschrift für Angiologie, Gefäßchirurgie,

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“…Serious adverse events (death or hospitalization) were not reported. 72 Use of CCBs may also be limited by hypotension. 21,69 When starting these medications, the lowest dose should be prescribed and gradually titrated every 4 weeks depending on a patient's response.…”

Section: Monitoring Of Patients With Primary Raynaud Phenomenon For Tmentioning

confidence: 99%

Recent advances in the workup and management of Raynaud’s phenomenon

Lis‐Święty

2019

Polish Archives of Internal Medicine

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oxide synthase 1 gene as significantly correlated with RP in the general population. 4 Major risk factors for primary RP include, in addition to the female sex and family history, a previous sensation of cold hands, migraine, cardiovascular diseases, decreased body mass index, manual occupation (not including vibration tool use), and estrogen replacement therapy. 3-6 Cigarette smoking and alcohol consumption are still of unclear significance when concerning the prevalence of primary RP. 7 Secondary RP associated with a known disease, mainly with systemic sclerosis (SSc) (>80% of patients) or other connective tissue diseases (CTDs), is rare and accounts for 10% to 20% of all RP cases. 8 Other common causes of secondary RP include diseases of arteries in the upper limbs (60% of RP occurring in individuals older than 60 years), malignancies, endocrine diseases, occupational syndromes, hematologic disorders, and infections (TABLE 1). 8,9 In addition, several Introduction Raynaud phenomenon (RP) is defined as recurrent, reversible episodes of vasospasm involving peripheral small vessels of the fingers and toes, at times also of the other acral sites (nose, ears, oral mucosa, lips, or nipples), when exposed to a cold environment or stressful situation. 1 This is characterized by a series of color changes in the affected area: first white (lack of blood flow), then bluish (deoxygenation of remaining blood), and red (reperfusion). Attacks can cause distal pain, burning, numbness, and paresthesia. 2 Regarding its etiology, RP is classified as primary (idiopathic) or secondary. Primary RP, which is an isolated finding without an underlying pathology, is common, occurring in about 5% of the general population living in areas with cold climates. 3 The prevalence of RP is higher in women (female-to-male ratio of 9 to 1). There is an associated genetic predisposition: one polymorphic variant was identified within the nitric

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“…It is administered at a dose of 30-120 mg three times daily orally. Verapamil (diphenylalkylamine class of CCBs) does not possess therapeutic effect in RP patients [75][76][77]. Nifedipine is the best studied and the most often used drug from dihydropyridine class CCBs.…”

Section: Primary Rpmentioning

confidence: 99%

Raynaud’s Phenomenon

Lambova¹

2018

Newest Updates in Rheumatology

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Raynaud's phenomenon (RP) is a clinical consequence of recurrent vasospasm of the small arteries and arterioles of the fingers and toes provoked by cold and emotional stress. RP is classified into two categories, i.e., primary and secondary RP. Primary RP is an isolated finding in the absence of an underlying pathology, while secondary RP is a syndrome in the context of another disease. The patients with primary RP have a younger age at onset, sparing of the thumb, and benign course without development of digital ulcers. Contrarily, secondary RP is characterized with later age of onset above 30 years, thumb involvement, and more severe course with possible development of trophic changes. In these cases, a focused, complaint-directed history and physical examination aim to reveal clinical symptoms and findings that confirm the presence of an underlying disorder, e.g., connective tissue disease (CTD) or other pathology. Together with clinical examination, laboratory, immunological, and capillaroscopic assessments facilitate the internal differential diagnosis of secondary RP. The capillaroscopic examination should be performed in all patients with symptoms of RP even in those cases without signs of systemic rheumatic disease, because the abnormal capillaroscopic picture inherits a high positive predictive value for the development of CTD.

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Calcium channel blockers for primary and secondary Raynaud's phenomenon

Abstract: Analysis 1.2. Comparison 1 CCBs vs placebo (generic inverse variance method), Outcome 2 Frequency of attacks (average/ week

Cited by 62 publications

References 71 publications

Raynaud-Phänomen

Raynaud-Phänomen

Recent advances in the workup and management of Raynaud’s phenomenon

Raynaud’s Phenomenon

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