Raynaud's phenomenon

Herrick, Ariane L.; Wigley, Fredrick M.

doi:10.1016/j.berh.2019.101474

Cited by 53 publications

(46 citation statements)

References 78 publications

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“…The primary deficit in PRP is considered to be a 'local fault' in vascular function of thermoregulation. 19 Central autonomous involvement has also been suggested to be important in the pathogenesis of connective tissue disease-associated RP. 20 Cold stimuli causes relocation of alpha 2c-adrenergic receptors from the Golgi apparatus to the cell surface, through activation of the rho kinase, which then increases the sensitivity of contractile proteins and subsequent vasoconstriction.…”

Section: Vascularmentioning

confidence: 99%

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Raynaud's phenomenon

Haque

Hughes

2020

Clinical Medicine

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Section: Vascularmentioning

confidence: 99%

“…22 Vasoconstriction compromises arteriovenous anastomoses and nutritional blood flow, which is further compounded in patients with SSc by vascular damage and occlusion. 18,19 Abnormalities in vasoactive peptides (eg of calcitonin generelated peptide vascular biology) have also been implicated in the pathogenesis of RP. 23…”

Section: Vascularmentioning

confidence: 99%

Raynaud's phenomenon

Haque

Hughes

2020

Clinical Medicine

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“…Raynaud's phenomenon (RP) is a well-characterized vasospastic condition in which patients experience transient ischemia of distal circulation. The constellation of clinical signs and symptoms includes pain, pallor, paresthesias, digital ulceration, and may even lead to gangrene [1][2][3]. While primary RP is idiopathic, there have been many noted etiologies of secondary RP syndrome, including combined chemotherapeutic regimens and paraneoplastic-associated malignancies [2,[4][5][6].…”

Section: Introductionmentioning

confidence: 99%

“…Management of chemotherapy-induced RP begins conservatively with behavioral changes. Once the symptoms progress, medical therapies are indicated and traditional modalities include the use of calcium channel blockers (CCBs), PDE-5 (phosphodiesterase type 5) inhibitors, nitrates, and prostacyclins [1,[3][4]. For severe or refractory cases of RP, more invasive therapies including nerve blocks, digital sympathectomies, and/or ultimately amputations have been described [1][2][3]7].…”

Section: Introductionmentioning

confidence: 99%

“…Once the symptoms progress, medical therapies are indicated and traditional modalities include the use of calcium channel blockers (CCBs), PDE-5 (phosphodiesterase type 5) inhibitors, nitrates, and prostacyclins [1,[3][4]. For severe or refractory cases of RP, more invasive therapies including nerve blocks, digital sympathectomies, and/or ultimately amputations have been described [1][2][3]7]. Conventional treatments of secondary RP have shown mixed results and are often limited by efficacy, side effects, and contraindications to chronic medical comorbidities [1,8].…”

Section: Introductionmentioning

confidence: 99%

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Use of Botulinum Toxin A to Treat Chemotherapy-Induced Raynaud’s Phenomenon

Potluri¹,

Lee²,

Song³

et al. 2021

Cureus

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Raynaud’s phenomenon (RP) is a vasospastic disorder of the digital blood vessels leading to pain, paresthesias, and pallor in response to cold or stress. RP can develop secondary to a number of pathologies or factors, including the use of chemotherapy agents. Typical first-line therapies for secondary RP may be contraindicated in patients with certain comorbidities. Here, we discuss a case in which botulinum toxin A (BTX-A) was used to treat chemotherapy-induced RP in a patient with non-small cell lung cancer (NSCLC). We provide a review of the existing literature on the clinical course and treatment modalities, including the use of BTX-A, for patients with secondary RP. A 56-year-old female with NSCLC received treatment with bevacizumab and pemetrexed. Her initial symptoms included progressive discoloration and pain in her fingertips, which hastily progressed to ischemia and subsequent dry gangrene. She was diagnosed with chemotherapy-induced RP, but traditional management options were complicated by acute congestive heart failure. BTX-A injections were administered at key locations on the wrist and hand, significantly improving her symptoms and slowing the progression of the gangrenous changes. RP can develop as sequelae of chemotherapy regimens. Clinical management may be complicated by underlying pathology and/or patient symptoms. BTX-A injections are an excellent non-operative therapeutic option for patients with secondary RP in cases where mainstay therapies may be contraindicated, thus decreasing pain, improving patient quality of life, and slowing the progression of gangrenous changes.

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Efficacy and Safety of Botulinum Toxin in Adults with Raynaud's Phenomenon Secondary to Systemic Sclerosis: A Multicenter, Randomized, Double‐Blind, Placebo‐Controlled Study

Senet

Maillard

Diot

et al. 2022

Arthritis & Rheumatology

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Objective To determine whether a single session of botulinum toxin type A (BTA) injections into both hands more effectively decreases the frequency of systemic sclerosis–associated Raynaud's phenomenon (SSc‐RP) episodes than placebo. Methods This multicenter, randomized, double‐blind, placebo‐controlled, parallel‐group phase III trial in patients with SSc‐RP assessed the effect of 50‐unit BTA or placebo injections into the palms of both hands around each neurovascular bundle during 1 session in winter. The primary end point was the between‐group difference in the median change in the number of RP episodes from baseline (day 0) to 4 weeks postinjection. Values between the groups were compared with the Wilcoxon rank‐sum test. Results The intent‐to‐treat analysis included 46 BTA‐treated patients and 44 placebo recipients. At 4 weeks after assigned treatment injections, the median number of daily RP episodes decreased comparably in the BTA and placebo groups (median change –1 episode/day [interquartile range (IQR) –1.5, 0 episodes/day] and –1 episode/day [IQR –2.5, 0 episodes/day], respectively) (P = 0.77 versus placebo). Moreover, change in Raynaud's Condition Score, quality of life assessed by Health Assessment Questionnaire disability index, and hand function assessed by shortened Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and Cochin Hand Function Scale from baseline to follow‐up weeks 4, 12, and 24 did not differ significantly between groups. The BTA group experienced transient hand muscle weakness significantly more frequently (P = 0.003). Conclusion Neither the primary nor secondary end points were reached, and our results do not support any beneficial effect of palmar BTA injections to treat SSc‐RP.

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Raynaud's phenomenon

Cited by 53 publications

References 78 publications

Raynaud's phenomenon

Raynaud's phenomenon

Use of Botulinum Toxin A to Treat Chemotherapy-Induced Raynaud’s Phenomenon

Efficacy and Safety of Botulinum Toxin in Adults with Raynaud's Phenomenon Secondary to Systemic Sclerosis: A Multicenter, Randomized, Double‐Blind, Placebo‐Controlled Study

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