29(2):89-91. Arthritis Rheum. Raynaud Syndrome. 94 (20):e780. Edwards CM, Marshall JM, Pugh M. Lack of habituation of the pattern of cardiovascular response evoked by sound in subjects with primary Raynaud's disease. 54 (2):490-4. Increased whole blood platelet aggregation in patients with Raynaud's phenomenon with or without systemic sclerosis. In animal studies it has also been shown to alter prostaglandin production with disproportionate increases in thromboxane in rabbit endothelium resulting in vasospasm, platelet activation and thrombus formation 62, 63, although in some cases cocaine vasculopathy is more likely to be related to a Buergerlike syndrome 64, 65, 66 as described with cannabis use or arsenic exposure 67, 68, 69. Irbesartan blocks the vasoconstrictive and aldosterone-secreting effects of angiotensin II at the tissue receptor site In addition, it does not affect the response to bradykinin and is less likely to be associated with cough and angioedema. The prevalence of RP in vinyl chloride workers ranges from 6 to 33% 106. Grenoble Alpes, F38000, Grenoble, 4CHU GrenobleAlpes, Clinique de Mdecine Vasculaire, F38000, Grenoble, 5Ple Recherche, Pharmacologie Clinique Inserm CIC1406, CHU GrenobleAlpes, F38000, Grenoble, France. Serotonin has been shown to play a significant role in diseases related to vascular dysregulation like Raynaud's phenomenon (Hollenberg, 1988), erythromelalgia (Rudikoff and Jaffe, 1997), migraine (Bonvento et al., 1991) and perimenopausal hot flushes (Berendsen, 2000). Ranolazine is a new medication that does not affect the blood pressure or heart rate and is used to treat: chronic stable angia. 2018 Sep. 70 (9):1489-1499. It is interesting to note that bleomycin is used to induce a sclerodermic phenotype in animals 102, scleroderma being the main aetiology of secondary RP. Recent data suggest a possible involvement of tyrosine kinase inhibitors (TKI), through an unknown mechanism. , [QxMD MEDLINE Link]. 31 Nevertheless, a large casecontrol study (542 cases and 2155 controls) did not support the association between dopamine agonists and an increased risk of ischaemic events requiring hospitalization 35. 375 (6):556-65. [QxMD MEDLINE Link]. Central stimulation of the dopaminergic and noradrenergic system is responsible for the peripheral release of catecholamines leading to vasoconstriction. Silent alpha(2C)-adrenergic receptors enable cold-induced vasoconstriction in cutaneous arteries. Occasionally, other acral parts (eg, nose, tongue) are affected. [QxMD MEDLINE Link]. Br J Rheumatol. and transmitted securely. Furspan PB, Chatterjee S, Freedman RR. On one hand, a pilot study 129 that included three SSc patients treated with 100 mgday1 of imatinib for 6 months showed improvement of their RP 86. Federal government websites often end in .gov or .mil. Heparin prevents recurrence of a clot after spontaneous fibrinolysis. . Numerous case reports illustrating this effect are found in the literature 25, 26. On direct questioning of patients taking IFN 117, symptoms of RP were reported by more than half. Neuromuscular Blocker Agents, Botulinum Toxins, American College of Physicians-American Society of Internal Medicine, Sigma Xi, The Scientific Research Honor Society, Central Society for Clinical and Translational Research. 2009 May. J Am Acad Dermatol. An Autoimmune Basis for Raynaud's Phenomenon: Murine Model and Human Disease. The use of Ginkgo biloba in Raynaud's disease: a double-blind placebo-controlled trial. Wigley FM, Flavahan NA. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. [QxMD MEDLINE Link]. Tamaki Z, Asano Y, Hatano M, Yao A, Kawashima T, Tomita M, Kinugawa K, Nagai R, Sato S. Efficacy of lowdose imatinib mesylate for cutaneous involvement in systemic sclerosis: a preliminary report of three cases, Raynaudlike phenomenon in two patients on nilotinib. [QxMD MEDLINE Link]. 336(8730):1530-3. Kim H, Jones AJ, Labadzhyan A, Placencio-Hickok VR, Wallace DJ, Gong J, et al. 2012 Jun. 1990 Apr. 2021 May. Two cases of RP induced by reboxetin, an inhibitor of norepinephrine reuptake, have been described 47. After 3 weeks of therapy, the digital lesion was completely healed. 82 (1):6-16. Use of nitroglycerin ointment to treat primary and secondary Raynaud's phenomenon: a systematic literature review. [QxMD MEDLINE Link]. [QxMD MEDLINE Link]. Herbert S Diamond, MD Visiting Professor of Medicine, Division of Rheumatology, State University of New York Downstate Medical Center; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital [QxMD MEDLINE Link]. Causes Experts don't fully understand the cause of Raynaud's attacks. [QxMD MEDLINE Link]. Role and rationale for extended periarterial sympathectomy in the management of severe Raynaud syndrome: techniques and results. 2010 Mar 24. 51 (6):1200-1204. No significant correlation was seen with the cumulative or single doses of cisplatin, etoposide or vinblastine, serum magnesium concentrations during or after chemotherapy or a history of smoking 73. This website also contains material copyrighted by 3rd parties. 278(4):H1075-83. Rheumatol Int. This probably contributes to the underestimation of druginduced RP, as well as the fact that RP is a usually benign condition. Phosphodiesterases are a complex group of enzymes that help to tightly regulate the degradation of intracellular cyclic nucleotides. None is currently approved for this indication by the US Food and Drug Administration (FDA). Intracellular responses to both NO and prostacyclin are mediated by the cyclic nucleotides cGMP and cyclic adenosine monophosphate (cAMP), respectively. Raynaud's phenomenon is found among people who take Lexapro, especially for people who are female, 50-59 old, have been taking the drug for 1 - 6 months. Prevention of vascular damage in scleroderma and autoimmune Raynaud's phenomenon: a multicenter, randomized, double-blind, placebo-controlled trial of the angiotensin-converting enzyme inhibitor quinapril. Lemberger L, Bergstrom RF, Wolen RL, Farid NA, Enas GG, Aronoff GR. [QxMD MEDLINE Link]. The most common adverse effect of nitrate therapy is: headache. Chotani MA, Flavahan S, Mitra S, Daunt D, Flavahan NA. Bosentan is approved in the United Kingdom for the prevention of new digital ulcers in patients with systemic sclerosis. This happens when your blood vessels spasm from stress or cold temperatures. [Full Text]. Data concerning sympathomimetic nasal decongestants (pseudoephedrine, phenylephrine) are scarce. Wigley FM, Herrick AL, Flavahan N. Drugs with clear evidence of benefit shown through randomized controlled trials include calcium channel blockers and the vasodilator iloprost. Barreira RI, Garca BB, Lpez MG, Legazpi IR, Daz H, Penn IR. Cases of RP induced by central nervous system stimulants have been reported 50. 2015. RP cases have been reported following the use of bromocriptine, another ergot alkaloid 29, 30, 31, 32. [Full Text]. Our objective was therefore to review available evidence about this adverse drug effect and to propose a mechanistic approach of druginduced RP. In a healthy vascular bed it has been proposed that blocking serotonin reuptake could increase free plasma serotonin concentrations and produce, in stasis conditions, a local accumulation of serotonin, exacerbating vasoconstriction through 5HT2 receptors that may worsen RP 44. Botulinum toxin A in the treatment of Raynaud's phenomenon: a systematic review. None is currently approved for this indication by the US Food and Drug Administration (FDA).. Treatment of Raynaud's phenomenon with escitalopram Int J Neuropsychopharmacol. [Full Text]. On the other hand, exactly the opposite reaction has been described with other TKIs. Like chemotherapy agents, beta-blockers have long been associated with Raynaud's because they slow heart rate and lower blood pressure, the researchers noted. The dopamine receptor D2 agonist bromocriptine inhibits glucosestimulated insulin secretion by direct activation of the alpha2adrenergic receptors in beta cells. Its mechanism of action is thought to be potentiation of serotonergic activity in the CNS, resulting from inhibition of CNS neuronal reuptake of serotonin. Cocaine and Buerger disease: is there a pathogenetic association? Cracowski, J. Our objective in the present work was therefore to summarize available evidence and to propose a mechanistic approach of druginduced RP. Sertraline selectively inhibits presynaptic serotonin reuptake, with minimal or no effect on reuptake of norepinephrine or dopamine. [QxMD MEDLINE Link]. , The https:// ensures that you are connecting to the [QxMD MEDLINE Link]. On the one hand, SSRIs have been proposed as a treatment for RP, following the observation of the relief of patients with erythromelalgia or RP with fluoxetine and sertraline 38, or paroxetine and escitalopram 39. Fish-oil dietary supplementation in patients with Raynaud's phenomenon: a double-blind, controlled, prospective study. Raynaud's syndrome, also known as Raynaud's disease or Raynaud's phenomenon, is a condition that causes brief episodes where little or no blood flows to certain parts of your body after exposure to cold or sometimes stress. Courtesy of the CDC. Citalopram enhances serotonin activity through selective reuptake inhibition at the neuronal membrane. Rheumatology (Oxford). Raynaud's Syndrome is a condition in which cold temperatures or strong emotions cause blood vessel spasms that block blood flow to the fingers, toes, ears, and nose. [Full Text]. [Full Text]. Acta Reumatol Port. ebryk P, Puszczewicz MJ. Smitaman E, Pereira BP, Huang BK, Zakhary MM, Fliszar E, Resnick DL. These drugs also can help heal sores on fingers or toes. Osman EA, Barrett JJ, Bewick M, Parsons V. Does cyclosporin affect renal blood vessels? Incidence, remission, and persistence of Raynaud's phenomenon in the general population of northern Sweden: a prospective study. One of them experienced improvement after the treatment was switched to imatinib, with recurrence of RP on the reintroduction of nilotinib. But blood vessels in the hands and feet appear to react too strongly to cold temperatures or stress. Raynaud's syndrome causes spasms in small blood vessels in your fingers and toes. Iloprost is a synthetic analogue of prostacyclin (prostaglandin I2 [PGI2]) that dilates systemic and pulmonary arterial vascular beds. 92(7):1166-80. Fluoxetine selectively inhibits presynaptic serotonin reuptake with minimal or no effect in the reuptake of norepinephrine or dopamine. More recent research has shown promise in using ED drugs such as sildenafil (Viagra), vardenafil (Levitra), and talkalafil (Cialis) in treating Raynaud's symptoms, particularly when traditional treatments such as vasodilators and topical nitroglycerine-based creams provide insufficient relief or aren't well tolerated. Cozzolino F, Torcia M, Lucibello M, Morbidelli L, Ziche M, Platt J, Fabiani S, Brett J, Stern D. Interferonalpha and interleukin 2 synergistically enhance basic fibroblast growth factor synthesis and induce release, promoting endothelial cell growth. Expert Rev Clin Immunol. These agents are used for vasodilation and for their possible antifibrotic and anti-inflammatory effects. Serotonin reuptake inhibitors, Raynaud's phenomenon and erythromelalgia, Treatment of Raynaud's phenomenon with escitalopram, Int J Neuropsychopharmacol Off Sci J Coll Int Neuropsychopharmacol CINP. Escitalopram is an SSRI and an S-enantiomer of citalopram. It displaces angiotensin II from AT1 receptors and may lower blood pressure by antagonizing AT1-induced vasoconstriction, aldosterone release, catecholamine release, arginine vasopressin release, water intake, and hypertrophic responses. Thirteen percent of patients still suffered from RP 10 years after having received a cumulative bleomycin dose of <180000IU (corresponding approximately to three cycles of cisplatinetoposidebleomycin), 24.6% after a cumulative dose of 180 000 IU to 360 000IU, and 29% after a cumulative dose >360 000 IU. On the other hand, other authors have described a deleterious association between RP and the SSRIs, fluoxetine 41, 42, fluvoxamine 43, citalopram 44 and milnacipran 45, together with the relief of erythromelalgia symptoms 46. Before [QxMD MEDLINE Link]. These drugs include: Calcium Channel Blockers. De Angelis R, Silveri F, Bugatti L, Filosa G. Raynaud's phenomenon after combined adjuvant chemotherapy for breast cancer, Raynaud's phenomenon in patients treated with cisplatin, vinblastine, and bleomycin for germ cell cancer: measurement of vasoconstrictor response to cold, Vascular toxicity and the mechanism underlying Raynaud's phenomenon in patients treated with cisplatin, vinblastine and bleomycin. [QxMD MEDLINE Link]. As a library, NLM provides access to scientific literature. 6 (1):41. Nicardipine is used for vasodilatation and possible antiplatelet effects. A study in 1995 that included 90 patients treated with cisplatinbased chemotherapy for more than 1 year after testicular cancer found that 37% of them had developed RP after four cycles of chemotherapy combining cisplatin, bleomycin and vinblastine 73. Ergotamine in the acute treatment of migraine A review and European consensus, Dihydroergotamine, ergotamine, methysergide and sumatriptanbasic science in relation to migraine treatment, Goodman and Gilman's the pharmacological basis of thera peutics, [Finger tip necroses after dihydroergotamine medication in limited systemic scleroderma], Hautarzt Z Fr Dermatol Venerol Verwandte Geb, Severe vasospasm following ergot administration, O'Keeffe ST, Tsapatsaris NP, Beetham WP Jr, Association between Raynaud's phenomenon and migraine in a random population of hospital employees. [QxMD MEDLINE Link]. [QxMD MEDLINE Link]. Role of the renin-angiotensin-aldosterone system in vascular remodeling and inflammation: a clinical review. Duprez DA. Cureus. Nilsson T, Wahlstrm J, Burstrm L. Hand-arm vibration and the risk of vascular and neurological diseases-A systematic review and meta-analysis. Raynaud syndrome is vasospasm of parts of the hand in response to cold or emotional stress, causing reversible discomfort and color changes (pallor, cyanosis, erythema, or a combination) in one or more digits. [QxMD MEDLINE Link]. Doses may need to be adjusted for renal or hepatic impairment. Quarta S, Galea N, Gigante A, Romaniello A, Rosato E, Carbone I. The need for future high quality research including prospective and vascular physiology studies to clarify these mechanisms is obvious. Moreover four case studies of RP induced by ciclosporin use have been described. [QxMD MEDLINE Link]. Ascherman DP, Zang Y, Fernandez I, Clark ES, Khan WN, Martinez L, et al. 2014 Oct. 18(5):1-4. The positive results prompted researchers to study newer drugs in the ED class as potential therapies for Raynaud's, including vardenafil (Levitra) and taldalafil (Cialis) - both drugs appear promising in their ability to reduce the duration and . Moreover, new signals are emerging from case reports and small series. Smith V, et al; EULAR Study Group on Microcirculation in Rheumatic Diseases and the Scleroderma Clinical Trials Consortium Group on Capillaroscopy. Surprisingly, two cases of erythromelalgia have been described with bromocriptine, in association with calcium channel blockers 36, 37. When these treatments are started in patients with a history of RP, careful monitoring must be made and, if possible, alternative therapies that do not alter peripheral blood flow should be considered. Herrick AL. Bertoli R, Girardin F, Russmann S, Lauterburg BH. 2005 Apr. When this happens, blood can't get to the surface of the skin and the affected areas turn white and blue. Hand-arm vibration syndrome: What family physicians should know. A retrospective casecontrol study investigated whether medications used for the treatment of attention deficit hyperactivity disorder (ADHD) were associated with the development of RP. Berger CC, Bokemeyer C, Schneider M, Kuczyk MA, Schmoll HJ. Longterm neurologic and peripheral vascular toxicity after chemotherapy treatment of testicular cancer. It is worth noting that drugs increasing blood viscosity such as erythropoietins or intravenous immunoglobulins are not a known cause of RP. Further relevant papers were identified from the reference lists of retrieved articles. 38(2):114-21. In Raynaud's disease, smaller arteries that supply blood to the skin narrow. 48(7):791-5. Any movement you make over and . Bunker CB, Goldsmith PC, Leslie TA, Hayes N, Foreman JC, Dowd PM. Semin Arthritis Rheum. [QxMD MEDLINE Link]. Sakurai T, Goto K. Endothelins. [QxMD MEDLINE Link]. 52(4):1259-63. When the blood flow returns, the skin turns red and throbs or tingles. Agonist and Antagonist Properties at Subtypes of Dopamine D2Like Receptor and 1/2Adrenoceptor. JCO Oncol Pract. Heather Hansen-Dispenza, MD Rheumatology Fellow, University of Arizona College of Medicine , Heather Hansen-Dispenza, MD is a member of the following medical societies: American College of Physicians, American College of RheumatologyDisclosure: Nothing to disclose. adrenoceptor blockers have long been known as causing druginduced RP, but data about its prevalence are scarce. When avoiding triggers of Raynaud's phenonenon isn't possible or working to eliminate symptoms, often times, medication is used. Clin Epidemiol. Glendenning JL, Barbachano Y, Norman AR, Dearnaley DP, Horwich A, Huddart RA. Medscape Education, Short Cases in Pulmonary Arterial Hypertension, 20021355650-overviewDiseases & Conditions, encoded search term (Raynaud Phenomenon) and Raynaud Phenomenon, Vascular Occlusive Syndromes of the Upper Extremity, EULAR Systemic Sclerosis Recommendations Now Include Immunosuppressants, Headache and Systemic Lupus Erythematosus, Connective Tissue Disease-Interstitial Lung Disease, Abnormal Findings on the Hands: Clues to Systemic Disease, The First Signs of Elusive Dysautonomia May Appear on the Skin. Br J Clin Pharmacol. Nat Rev Rheumatol. High affinity for 1adrenoceptors does not protect from RP while ancillary properties such as intrinsic sympathomimetic activity and vasodilator properties seem to be protective (Khouri et al., submitted to British Journal of Clinical Pharmacology). [Full Text]. Cracowski, J. So, by bolstering the vasodilatory effect of both NO and prostacyclin, these agents may be useful in the treatment of Raynaud phenomenon. Acrocyanosis induced by interferon alpha(2a). Treatment should be initiated at the lowest dose available and titrated upward as tolerated, with the goal of diminishing the frequency and/or severity of attacks. RP typically appeared 3 to 6 months after the start of chemotherapy and often persisted for several years 74. Arbouw MEL, Movig KLL, Guchelaar HJ, Neef C, Egberts TCG. 2016 Feb 2. Furthermore, a trend towards the increased prevalence of RP was observed in patients who received bleomycin as a bolus compared with continuous infusion. FOIA , [QxMD MEDLINE Link]. A vasospastic effect of ciclosporin on both the macro and microcirculation has been shown 58 leading to systematic monitoring of hypertension or acute renal failure in the early treatment phase. NewmanTancredi A, Cussac D, Audinot V, Nicolas JP, Ceuninck FD, Boutin JA, Millan MJ. Zernikow B, Fleischhack G, Hasan C, Bode U. Cyanotic Raynaud's phenomenon with conventional but not with liposomal amphotericin B: three case reports. Indeed in each patient, RP was attenuated at around 3 months and had completely disappeared at 6 months. 134(3):399-406. Cocaineinduced Raynaud's phenomenon and ischaemic finger necrosis. Thus, pharmacologic properties of these drugs and their poor clinical benefit suggest that they should be contraindicated in patients with sclerodermarelated RP 60. [QxMD MEDLINE Link]. Falappa P, Magnavita N, Bergamaschi A, Colavita N. Angiographic study of digital arteries in workers exposed to vinyl chloride. 1-5. Another patient experienced recurrent RP with nilotinib 131. AJR Am J Roentgenol. , 1993 Nov. 46(5):795-804. Papamichael D, Amft N, Slevin ML, D'Cruz D. 5Fluorouracilinduced Raynaud's phenomenon. Unfortunately this study did not provide detailed information on RP. Maricq HR, Johnson MN, Whetstone CL, LeRoy EC. 43:980-981. Zhou F, Huang E, Zheng E, Deng J. The pathophysiology of RP induced by cancer chemotherapies is not well understood and is probably multifactorial. 19 (3):102458. Prevalence of Raynaud phenomenon and nailfold capillaroscopic abnormalities in Fabry disease: a cross-sectional study. Please confirm that you would like to log out of Medscape. Further relevant papers were identified from the reference lists of retrieved articles. 2016 Feb 25. Merritt WH. [QxMD MEDLINE Link]. The acute effects of cigarette smoking on cutaneous blood flow in smoking and non-smoking subjects with and without Raynaud's phenomenon. intrinsic sympathomimetic activity, 1selectivity, vasodilator activity) should theoretically influence their propensity to induce peripheral vasoconstriction, although studies report conflicting results 13, 14, 15, 16. ), or other systemic diseases 1. First you experience cold, puffy fingers changing colors to white and blue as they go. Raynaud's phenomenon (RP) is the transient digital ischemia that occurs upon exposure to cold temperature or emotional distress. It is not known how Lexapro works, but it is thought to block the reuptake of serotonin by nerves. 2017 Jul 6. Khouri, C. BalbirGurman A, BraunMoscovici Y, Nahir AM. This present review summarises the prevalence and level of evidence of the association between drugs and RP (Table1). Staying warm, avoiding rapid changes in temperature, and managing stress levels can help. [Full Text]. Rheumatology (Oxford). Although some case reports of RP induced by interferons are described without any immune deficiency 122 it is known that interferon therapy can be related to an autoimmune disease 123, 124. 2015 Feb. 31 (1):101-20. [QxMD MEDLINE Link]. There is no evident explanation for this discrepancy, but the studies have small sample size. [Full Text]. Destors JM, Gauthier E, Lelong S, Boissel JP. Some authors suggested that endothelial damage is necessary for the development of a vasoconstrictive effect during SSRI treatment 48. Its action is independent of the pathways for angiotensin II synthesis. Carpentier, P. These symptoms caused by the constriction of small blood vessels in the hands or feetcan last for seconds to hours, but most often last around 15 minutes. Serotonin is a potent vasoconstrictor that is released from nerve endings and during platelet activation. 7:161-8. Of the dihydropyridines, nifedipine has been extensively studied; however, in the same category, felodipine, amlodipine, and isradipine seem to be equally effective. The remaining patients needed specific medication and six amputations were necessary, underlining the severity of this adverse reaction. 1998 Sep. 95(3):249-60. Share cases and questions with Physicians on Medscape consult. 12 (7):e0180795. Arthritis Rheumatol. Thromb Haemost. Druginduced RP is a probably underestimated adverse drug event, with limited available evidence regarding its prevalence. In addition to producing vasodilation, it also contributes to inhibition of platelet aggregation and plays a role in inhibition of smooth muscle proliferation. Deshayes S, Auboire L, Jaussaud R, Lidove O, Parienti JJ, Triclin N, et al. Another possible mechanism is the neurotoxicity of chemotherapies toward arteriolar tone regulation, particularly through hypomagnesia related to cisplatin administration leading to dysregulation of vascular smooth muscle tone 101. ), Raynaud's Phenomenon: A Guide to Pathogenesis and Treatment. Foss SD, Lehne G, Heimdal K, Theodorsen L. Clinical and biochemical longterm toxicity after postoperative cisplatinbased chemotherapy in patients with lowstage testicular cancer. 11561116 DOI: 10.1093/rheumatology/40.9.1038 Abstract Objective: To compare fluoxetine, a selective serotonin reuptake inhibitor, with nifedipine as treatment for primary or secondary Raynaud's phenomenon. Risk factors for Raynaud's phenomenon in the workforce. Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, Phi Beta KappaDisclosure: Nothing to disclose. Experimental studies have shown that receptors with a tyrosine kinase activity may play a role in the exaggerated vasoconstriction in response to cold 128. Karabacak K, Kadan M, Kaya E, Durgun B, Arslan G, Doganci S, Bolcal C, Demirkilic U. Oxaliplatin induced digital ischemia and necrosis, Raynaud's phenomenon possibly induced by a compund drug of tegafur and uracil. Severe Raynaud's phenomenon with chronic hepatis C disease treated with interferon. Best Pract Res Clin Rheumatol. In patients with rapidly advancing ischemia, anticoagulant therapy may be necessary. Zaima C, Kanai M, Ishikawa S, Kawaguchi Y, Masui T, Mori Y, Nishimura T, Matsumoto S, Yanagihara K, Chiba T, Mimori T. A case of progressive digital ischemia after early withdrawal of gemcitabine and S1 in a patient with systemic sclerosis. AlZahrani H, Gupta V, Minden MD, Messner HA, Lipton JH. [QxMD MEDLINE Link]. Medications Used To Treat Raynaud Phenomenon. L. , A pilot study. Mueller M, Gschwandtner ME, Gamper J, Giurgea GA, Charwat-Resl S, Kiener HP, et al. , 2011 Jul. The vascular endothelial toxicity of vinyl chloride has been shown by angiographic studies of arteries in the hand and by capillaroscopy 104, 105. 41 (5):943-949. The narrowed arteries limit blood flow. Arinsoy T, Derici U, Yuksel A, Reis KA, Sindel S. Cyclosporinea treatment and a rare complication: Raynaud's phenomenon. The onset of depression relief may be obtained after 1-2 weekssooner than is possible with other antidepressants. Bethesda, MD 20894, Web Policies Raynaud's phenomenon is characterized by episodic vasospasm of the extremities precipitated by cold or emotional stress. Longterm treatment with endothelin receptor antagonist bosentan and iloprost improves fingertip blood perfusion in systemic sclerosis. [QxMD MEDLINE Link]. Schematic representation of some of the key mechanisms contributing to the pathogenesis of iatrogenic Raynaud's phenomenon, Most relevant prevalence and level of evidence (defined by the Oxford Centre for Evidencebased Medicine Levels of Evidence) of the association between each drug and RP. [QxMD MEDLINE Link]. Nagarajan M, McArthur P. Targeted high concentration botulinum toxin A injections in patients with Raynaud's phenomenon: a retrospective single-centre experience. Drugs used to treat Raynaud's Syndrome The following list of medications are in some way related to or used in the treatment of this condition. Efficacy of Botulinum Toxin B Injection for Raynaud's Phenomenon and Digital Ulcers in Patients with Systemic Sclerosis. However numerous hypotheses have been proposed: a direct vasospastic effect 113, 120, increasing levels of intracellular fibroblast growth factor in endothelial cells leading to proliferation of these cells and increasing angiogenesis 121 and induction or exacerbation of a dormant collagen disease 109. 2002. 64 (6):898-904. Raynaud phenomenon and mortality: 20+ years of follow-up of the Charleston Heart Study cohort. Raynaud's syndrome is a condition in which a person's fingers, and sometimes toes, turn blue and/or white upon exposure to cold, and then bright red upon rewarming. [QxMD MEDLINE Link]. Suter LG, Murabito JM, Felson DT, Fraenkel L. The incidence and natural history of Raynaud's phenomenon in the community. Flow diagram of studies included in the review. [QxMD MEDLINE Link]. 2022 Jul 6. Increasing blood viscosity by induction of serum cryoprecipitation 125, deposition of immune complexes 126 and arterial occlusion by thrombi due to the procoagulant activity of interferon 112, 113 have been proposed. Agents in this class may be used in patients with systemic sclerosis and digital ulcers. They authors do not have any conflict of interest that might bias the present work. Nitroglycerin ointment. The prevalence of RP in the general population varies between 0.5 and 19%, with major geographic variability 3, 4, 5, 6. 2017 Mar. 97 (7):843-850. 63 (3):206-210. 7 (4):265-7. 2021 Mar. Vascular actions and clinical implications. Standardisation of nailfold capillaroscopy for the assessment of patients with Raynaud's phenomenon and systemic sclerosis. Spasms of blood vessels happen in response to cold, stress, or emotional upset. 28 (5):553-9. After withdrawal of ciclosporin, symptoms improved in 89% 54. 2009 Jul. Some studies showed an exaggerated response to cold not only in patients with RP but also in patients without finger symptoms before testicular chemotherapy 74, 98. 48(7):1992-2000. [QxMD MEDLINE Link]. Can Fam Physician. Zhu JL, Black SM, Chen HW, Jacobe HT. Jeffrey R Lisse, MD, FACP Professor, Department of Internal Medicine, Chief, Section of Rheumatology, University of Arizona School of Medicine Raynaud's disease causes pain in the extremities in response to cold temperatures or stress. 2016. It is used for the treatment of depression. To our knowledge, no pathophysiologic mechanism has been identified yet. Among other cancer chemotherapies that could be responsible for RP, there is limited evidence for gemcitabine 90, 91, 92, vincristine 93, 5fluorouracil 94, oxaliplatin 95, tegafur and uracil 96 and cyclophosphamidemethotrexate5fluorouracil adjuvant therapy 97. The disorder may be primary or secondary. 2014 Nov. 34 (11):1623-6. Treatment. In both cases, abnormalities of the cutaneous microcirculation are primarily involved in the pathophysiology of RP 2. Quality research including prospective and vascular physiology studies to clarify these mechanisms is obvious and Raynaud... Indication by the US Food and Drug Administration ( FDA ) Legazpi,. Trials Consortium Group on Microcirculation in Rheumatic Diseases and the risk of vascular neurological! Observed in patients with Raynaud 's phenomenon with chronic hepatis C disease treated with interferon be obtained after weekssooner. 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