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Raynaud phenomenon in systemic sclerosis — SCE Rheumatology MCQ

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ModerateConnective tissue diseasesRaynaud phenomenon in systemic sclerosisSCE Rheumatology

A 38-year-old woman with limited systemic sclerosis has painful triphasic colour change in the fingers. Examination shows digital pitting is present but no critical ischaemia. Investigations show blood pressure is normal and pregnancy test is negative. What is the most appropriate management?

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Correct answer: A — Start a dihydropyridine calcium-channel blocker

A calcium-channel blocker such as nifedipine is standard first-line drug therapy for Raynaud symptoms in systemic sclerosis when conservative measures are insufficient. Warfarin and immediate sympathectomy are inappropriate for uncomplicated Raynaud symptoms. Digital ulcers or critical ischaemia would require escalation and vascular assessment.

Reference: BSR systemic sclerosis guideline; EULAR systemic sclerosis recommendations