Primary Raynaud Treatment — SCE Rheumatology MCQ

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EasySoft Tissue RheumatologyPrimary Raynaud TreatmentSCE Rheumatology

A 45-year-old woman has primary Raynaud phenomenon with no clinical evidence of an underlying connective tissue disease. Her attacks remain troublesome despite keeping warm, avoiding cold exposure and stopping smoking. Which is the most appropriate first-line pharmacological treatment?

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Correct answer: C — Modified-release nifedipine

Modified-release nifedipine, a dihydropyridine calcium-channel blocker, is the usual first-line drug when primary Raynaud symptoms remain troublesome despite measures such as maintaining warmth, avoiding cold and stopping smoking. It promotes peripheral arterial vasodilatation and can reduce attack frequency, although the average benefit is modest. Headache, flushing, dizziness, hypotension and peripheral oedema may limit treatment. Intravenous iloprost is reserved for severe or refractory digital ischaemia rather than uncomplicated primary Raynaud phenomenon. Bosentan is principally used to prevent recurrent digital ulcers in systemic sclerosis and is not first-line treatment for primary disease. ACE inhibitors have no established first-line role. Propranolol may worsen peripheral vasospasm and should generally be avoided where possible.

Reference: Hughes M, et al. Practical management of Raynaud's phenomenon - a primer for practicing physicians. Current Opinion in Rheumatology. 2022;34:260-269. https://www.nhs.uk/conditions/raynauds/