Contemporary management of Raynaud's phenomenon and digital ischaemic complications.

PURPOSE OF REVIEW: The present review gives an update of the current management of Raynaud's phenomenon and its ischaemic complications (digital ulceration and critical ischaemia) and discusses possible further developments in the next 5-10 years. New approaches to therapy are being driven by increased understanding of pathophysiology and by increased international networking of clinicians and scientists, facilitating clinical trials.

RECENT FINDINGS: Key points include phosphodiesterase inhibitors most likely confer benefit, although clinical trials have given somewhat conflicting results, and have been short-term; a new topical, easy-to-use glyceryl trinitrate preparation has been shown to improve Raynaud's Condition Score; the endothelin-1 receptor antagonist bosentan has now been shown to reduce the number of new systemic sclerosis (SSc)-related digital ulcers in two multinational clinical trials; and although statin therapy is likely to confer benefit in SSc-related Raynaud's phenomenon, further research is required to confirm this.

SUMMARY: New therapeutic approaches in patients who do not respond to more traditionally used vasodilators include phosphodiesterase inhibitors and (for those with recurrent SSc-related digital ulcers) endothelin-1 receptor antagonism. Several other potential new therapies are being researched. Optimal management of digital ulceration is multidisciplinary including tissue viability and (sometimes) surgical input.