Non-invasive Methods of Assessing Raynaud’s Phenomenon

Murray, Andrea; Pauling, John D

doi:10.1007/978-1-4939-1526-2_13

Cited by 4 publications

(4 citation statements)

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“…Pauling et al [15 ▪▪ ] recently conducted a systematic review of studies incorporating laser Doppler methods, and Melsen et al [16 ▪ ] reviewed laser Doppler flowmetry. As with thermography [17,18], there has been a lack of standardization in imaging protocols and methodologies across laser Doppler studies. It is worth highlighting that of the 29 studies reviewed by Pauling et al [15 ▪▪ ], all but one were single-centre, perhaps underscoring the current ‘individuality’ of protocols and studies.…”

Section: Discussionmentioning

confidence: 99%

Raynaud's phenomenon and digital ulcers: advances in evaluation and management

Herrick¹

2021

Current Opinion in Rheumatology

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Purpose of reviewThe aim of this review is to give an update on advances in evaluation and management of systemic sclerosis (SSc)-related Raynaud's phenomenon and digital ulceration, focusing on reports from the last 18 months. The increasing recognition of the huge impact of Raynaud's phenomenon and of digital ulceration on the everyday lives of patients with SSc has sparked enthusiasm internationally to develop better outcome measures and better treatments, and so a review is timely.Recent findingsThere have been recent advances in the development of patient reported outcome instruments [e.g. the Hand Disability in Systemic Sclerosis-Digital Ulcers (HDISS-DU) instrument] and also in noninvasive imaging techniques, including thermography and laser Doppler methods. Improved outcome measures will facilitate future clinical trials, both early phase proof-of-concept and later phase trials. New insights have been gained into mechanisms of action and methods of administration of ‘conventional’ therapies, for example phosphodiesterase inhibitors and intravenous prostanoids. New treatment approaches are being investigated, including topical and procedural therapies.SummaryClinicians can look forward to seeing these advances translating into clinical benefit over the next 5 years. To help ensure this, they should strive whenever possible to recruit patients with SSc-related digital vasculopathy into observational studies and clinical trials.

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Section: Discussionmentioning

confidence: 99%

Raynaud's phenomenon and digital ulcers: advances in evaluation and management

Herrick¹

2021

Current Opinion in Rheumatology

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“…In LDF, light penetrating the skin from a single probe reaches moving erythrocytes in the blood and is scattered back to a photodetector. Light scattered from moving cells undergoes a small frequency change; this change in frequency is directly proportional to the speed and concentration of erythrocytes and thus allows for measurement of blood flow [11]. This technique is prone to movement artifact and has poor reproducibility.…”

Section: Outcomes Measuresmentioning

confidence: 99%

“…LDI overcomes limitation of LDF in that an area is scanned, rather than a single point, and blood cell velocity is measured at several points to construct a map of tissue perfusion [11]. This technique takes longer than LDF, though faster imagers have been developed at the cost of lower resolution images.…”

Section: Outcomes Measuresmentioning

confidence: 99%

“…LSCI allows simultaneous full field dynamic vascular assessment using optics. By directing a two-dimensional laser beam generated by optics, at an optically rough surface, a speckle pattern of reflections from the uneven surface is detected at the focal plane of the imaging lens [11]. If the laser is directed at areas where there is movement due to perfusion, the speckle contrast pattern will change, and changes in accordance to the velocity of blood flow.…”

Section: Outcomes Measuresmentioning

confidence: 99%

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Pharmacotherapy Options in the Management of Raynaud’s Phenomenon

Hinze

Wigley

2018

Curr Treat Options in Rheum

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Purpose of review: Multiple classes of medications have been studied for the treatment of Raynaud’s phenomenon (RP) with or without digital ischemia. The goal of this review is to discuss the outcomes of recent studies and to report on our approach to the management of RP in light of the available evidence. Recent findings: Comparing treatments for RP remains a challenge as efficacy endpoint vary widely among trials. While calcium channel blockers are used first-line in the pharmacologic management of RP, phosphodiesterase 5 inhibitors have also been shown to be beneficial in reducing symptoms. In the setting of digital ischemia, administration of intravenous prostanoids is the standard of care. Bosentan has shown benefit in the prevention of future ulcers in patients with scleroderma. Botulinum toxin therapy was ineffective in a clinical trial involving scleroderma patients; more controlled studies are needed in other subsets of patients. Digital sympathectomy may be beneficial in cases of critical digital ischemia, though recurrence of symptoms is common. Summary: Comparative effectiveness studies are needed to determine which therapeutic interventions are most beneficial in patients with RP. Based on the available evidence, we start with CCBs and add a phosphodiesterase inhibitor if symptoms are not controlled, or intravenous prostacyclin in the setting of severe critical digital ischemia. We may additionally add an endothelial receptor antagonist in cases of recurrent digital ulcers. A surgical sympathectomy may be used in refractory cases of digital ischemia. A digital block may also be a less invasive, but temporary, intervention allowing for titration of medical therapy.

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