The Curtis National Hand Center, Baltimore, MD, USA.
Semin Arthritis Rheum. 2012 Feb;41(4):599-603. doi: 10.1016/j.semarthrit.2011.07.006. Epub 2011 Aug 24.
Botulinum toxin A has conventionally been used in the upper extremity to treat spasticity resulting from stroke, paraplegia, and dystonia. Recently, it has been used to relieve symptoms of vasospasm in Raynaud's phenomenon. This review summarizes the current literature on botulinum toxin A in the treatment of Raynaud's phenomenon and examines the proposed mechanisms of action, suggested techniques of administration, and clinical efficacy.
An Ovid MEDLINE search from 1950 to September 2010 was performed to identify any reports on the use of Botulinum toxin in the treatment of Raynaud's disease or associated vasoconstrictive disorders. All studies pertaining to "Raynaud's disease," "Raynaud's," or "vasoconstriction" were queried and meshed with a secondary search of studies pertaining to "botox" or "botulinum toxin type A." These reports were meshed and subsequently limited to human studies. All studies that met criteria were included and their outcomes evaluated and summarized.
Since 2004, there have been 5 studies that have evaluated the use of Botulinum Toxin A for the treatment of Raynaud's. In each study, patients received a range of botulinum toxin injections (10-100 units) in their fingers and hands. The studies have many limitations (lack of controls, variable severity of disease, variability of dosing) but all report favorable clinical results. All showed overall improvement in patient pain as well as a reduction in soft tissue ulceration.
Initial reports on the use of botulinum toxin A for Raynaud's phenomenon are promising. Larger controlled trials with improved study design are warranted. A better understanding of the mechanism of action, appropriate dose and dose frequency, and the efficacy relative to other medical and surgical treatments requires investigation.
肉毒杆菌毒素 A 通常用于治疗因中风、截瘫和肌张力障碍导致的上肢痉挛。最近，它已被用于缓解雷诺现象的血管痉挛症状。本综述总结了肉毒杆菌毒素 A 治疗雷诺现象的现有文献，并检查了其作用机制、建议的给药技术和临床疗效。
通过 Ovid MEDLINE 搜索，从 1950 年至 2010 年 9 月，查找有关肉毒杆菌毒素治疗雷诺病或相关血管收缩性疾病的任何报告。查询了所有与“雷诺病”、“雷诺”或“血管收缩”相关的研究，并与二次搜索的与“肉毒杆菌毒素”或“肉毒杆菌毒素 A 型”相关的研究进行了合并。对这些报告进行了合并，然后将其限制在人类研究中。纳入了符合标准的所有研究，并评估和总结了其结果。
自 2004 年以来，已有 5 项研究评估了肉毒杆菌毒素 A 治疗雷诺病的效果。在每项研究中，患者的手指和手部接受了 10-100 单位的肉毒杆菌毒素注射。这些研究存在许多局限性（缺乏对照、疾病严重程度不同、剂量变化），但都报告了良好的临床结果。所有研究均显示患者疼痛总体改善，软组织溃疡减少。
关于肉毒杆菌毒素 A 治疗雷诺现象的初步报告令人鼓舞。需要进行更大规模的、设计改进的对照试验。需要进一步了解其作用机制、适当的剂量和剂量频率，以及与其他医疗和手术治疗相比的疗效。
