The University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK.
Curr Opin Rheumatol. 2011 Nov;23(6):555-61. doi: 10.1097/BOR.0b013e32834aa40b.
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.
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.
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.
本综述介绍了雷诺现象及其缺血性并发症（指端溃疡和严重缺血）的当前治疗方法的最新进展，并讨论了未来 5-10 年内可能的进一步发展。治疗方法的新方法是基于对病理生理学的深入了解和临床医生和科学家之间的国际网络的增加，从而促进了临床试验。
主要观点包括磷酸二酯酶抑制剂可能有益，尽管临床试验的结果有些矛盾，而且是短期的；一种新的局部、易于使用的硝化甘油制剂已被证明可以改善雷诺现象的状况评分；内皮素-1 受体拮抗剂波生坦现已证明可以减少两项多中心临床试验中系统性硬化症（SSc）相关的新指端溃疡的数量；尽管他汀类药物治疗可能对 SSc 相关的雷诺现象有益，但仍需要进一步研究来证实这一点。
对于那些对传统血管扩张剂反应不佳的患者，新的治疗方法包括磷酸二酯酶抑制剂和（对于那些有复发性 SSc 相关指端溃疡的患者）内皮素-1 受体拮抗剂。正在研究其他几种潜在的新疗法。最佳的指端溃疡管理是多学科的，包括组织活力和（有时）手术干预。
