- First-line treatments are calcium channel blockers (Ia, A) and angiotensin II receptor antagonists (Ib, C).
- Other treatments that may be considered are: selective serotonin reuptake inhibitors, α-blockers and statin therapy (III, C).
- Phosphodiesterase type 5 inhibitors are being used increasingly for SSc-related RP (IIa, C).
- Intravenous prostanoid (e.g. iloprost; Ia, B) and digital (palmar) sympathectomy (with or without botulinum toxin injection) should be considered in severe and/or refractory cases (III, D).
- DUs require integrated management by a multidisciplinary team; management includes local and systemic treatment (III, C).
- Oral vasodilator treatment should be optimized, analgesia optimized and any infection promptly treated (III, C).
- Sildenafil should now be used before considering i.v. prostanoids and bosentan, in line with the current National Health Service (NHS) England Clinical Commissioning policy  (I, A).
- In severe active digital ulceration, patients should receive i.v. prostanoid (Ia, B). In patients with recurrent, refractory DUs, a phosphodiesterase type 5 inhibitor (IIa, B) or i.v. prostanoid (Ia, B) and an endothelin receptor antagonist (including bosentan; Ia, B) should be considered.
- Digital (palmar) sympathectomy (with or without botulinum toxin injection) may also be considered in severe and/or refractory cases (III, D).
BSR and BHPR guideline for the treatment of systemic sclerosis
|The global Raynaud's trailblazer - Dr Howell and I, Sept 2017|
All of your monies will be used for medical research purposes only, lead by the world trail blazer Dr Kevin Howell.
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|Prof Chris Denton and I, Sept 2017|
This year, 2020, I am celebrating 22 years of being a patient at the Scleroderma Unit, The Royal Free Hospital - a world leading expert specialist, research centre.
|Chat Magazine May 2019|
|James Carver, myself, Prof Chris Denton|
I had the pleasure of being a presenter and part of the European co-hort who gave a presentation at the European Parliament, Brussels, in honour of World Scleroderma Day 2015.
I am immensely grateful to James Carver, former MEP, for organizing this event in memory of his late wife Carmen, who sadly passed from Scleroderma.
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