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BMJ Clin Evid. 2008; 2008: 1119.
Published online 2008 December 16.
PMCID: PMC2907991

Raynaud's phenomenon (primary)

Janet Elizabeth Pope, Rheumatologist

Abstract

Introduction

Raynaud’s phenomenon is an episodic vasospasm of the peripheral arteries, causing pallor followed by cyanosis and redness with pain and sometimes paraesthesia. On rare occasions it can lead to ulceration of the fingers and toes (and in some cases of the ears or nose). This review focuses on primary (idiopathic) Raynaud's phenomenon occurring in the absence of an underlying disease. The prevalence of primary Raynaud's phenomenon varies by sex, country, and exposure to workplace vibration.

Methods and outcomes

We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for primary Raynaud’s phenomenon? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2008 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).

Results

We found 15 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.

Conclusions

In this systematic review we present information relating to the effectiveness and safety of the following interventions: amlodipine, diltiazem, exercise, inositol nicotinate, keeping warm, moxisylyte (thymoxamine), naftidrofuryl oxalate, nicardipine, nifedipine, prazosin, and smoking cessation.

Key Points

Raynaud's phenomenon is episodic vasospasm of the peripheral arteries, causing pallor followed by cyanosis and redness with pain and sometimes paraesthesia. On rare occasions it can lead to ulceration of the fingers and toes (and in some cases of the ears or nose). This review focuses on primary (idiopathic) Raynaud's phenomenon occurring in the absence of an underlying disease.

  • Prevalence, which varies by sex and country, is around 3−5% in most population studies, 80−90% of which is primary Raynaud's phenomenon, and is slightly higher in women than in men.
  • Attacks may last from several minutes to a few hours, and long-term sufferers of initially idopathic Raynaud's phenomenon can later go on to display features of underlying disorders such as scleroderma.

Nifedipine seems to reduce the frequency and severity of Raynaud's attacks, although it is associated with high rates of adverse effects such as tachycardia, headache, and flushing.

Other drug treatments, such as nicardipine, naftidrofuryl oxalate, inositol nicotinate, and prazosin may successfully treat primary Raynaud's phenomenon, but we found no studies large enough to enable us to draw conclusions.

We found no evidence examining the efficacy of lifestyle changes, such as keeping warm, smoking cessation, and exercise in treating and preventing Raynaud's phenomenon.

About this condition

Definition

Raynaud's phenomenon is episodic vasospasm of the peripheral arteries, causing pallor followed by cyanosis and/or erythema, which can cause pain and sometimes paraesthesia, and, rarely, ulceration of the fingers and toes (and in some cases of the ears or nose). Primary or idiopathic Raynaud's phenomenon (Raynaud's disease) occurs without an underlying disease. Secondary Raynaud's phenomenon (Raynaud's syndrome) occurs in association with an underlying disease — usually connective tissue disorders such as scleroderma, systemic lupus erythematosus, rheumatoid arthritis, Sjogren’s syndrome, or polymyositis. This review excludes secondary Raynaud's phenomenon. Diagnosis: The diagnosis of Raynaud's phenomenon is by a history of clearly demarcated pallor of digit(s), followed by at least one other colour change (cyanosis, erythema), which is usually precipitated by cold. A good history, physical examination, and laboratory results can help rule out secondary Raynaud's phenomenon. Review of symptoms or signs for connective tissue disease should be done. Laboratory testing may include full blood count (FBC), erythrocyte sedimentation rate (ESR), and antinuclear antibodies (ANA) with pattern, if connective tissue diseases are suspected. Magnification of the nailbeds to observe abnormal capillaries is also important in order to rule out Raynaud's phenomenon associated with connective tissue diseases.

Incidence/ Prevalence

The prevalence of primary Raynaud's phenomenon varies by sex, country, and exposure to workplace vibration. One large US cohort study (4182 people) found symptoms in 9.6% of women and 8.1% of men, of whom 81% had primary Raynaud's phenomenon. Smaller cohort studies in Spain have estimated the prevalence of Raynaud's phenomenon to be 3.7-4.0%, of which 90% is primary Raynaud's phenomenon. One study in Japan (332 men, 731 women) found symptoms of primary Raynaud's phenomenon in 3.4% of women and 3.0% of men.A study of 12,907 people in the UK reported that 4.6% of people had demarcated finger blanching with cold exposure.

Aetiology/ Risk factors

The cause of primary Raynaud's phenomenon is unknown. There is evidence for genetic predisposition, usually in those with early-onset Raynaud's phenomenon (aged under 40 years). One prospective observational study (424 people with Raynaud's phenomenon) found that 73% of sufferers first developed symptoms before the age of 40 years. Women are at higher risk than men (OR 3.0, 95% CI 1.2 to 7.8, in 1 US case control study [235 people]). The other known risk factor is occupational exposure to vibration from tools (symptoms developed in about 8% with exposure v 2.7% with no exposure in 2 cohorts from Japan). People who are obese may be at lower risk.Exposure to cold, or heightened emotion can worsen symptoms. Rarely, primary Raynaud's phenomenon can progress to secondary. This occurs most commonly in people with auto-antibodies (e.g. anti-nuclear antibodies), increased erythrocyte sedimentation rate (ESR), and/or abnormal nailbed capillaries, and occurs at a rate of 2% for suspected secondary Raynaud's phenomenon and 1% for secondary Raynaud's phenomenon annually.

Prognosis

Attacks may last from several minutes to a few hours. One systematic review (search date 1996, 10 prospective observational studies, 639 people with primary Raynaud's phenomenon) found that 13% of long-term sufferers later manifested an underlying disorder such as scleroderma.Complications such as digital ulcers are extremely rare in primary Raynaud's phenomenon.

Aims of intervention

To reduce the number and severity of attacks; to prevent tissue damage; to minimise adverse effects of treatment.

Outcomes

Frequency and severity of symptoms (as assessed by patient diary); severity assessed by visual analogue scales, Likert scales, or the Raynaud's Condition Score; rates, size, and healing of digital ulceration.

Methods

Clinical Evidence search and appraisal May 2008. The following databases were used to identify studies for this systematic review: Medline 1966 to May 2008, Embase 1980 to May 2008, and The Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Clinical Trials 2008, Issue 2. An additional search used the NHS Centre for Reviews and Dissemination (CRD) — for Database of Abstracts of Reviews of Effects (DARE) and Health Technology Assessment (HTA). We also searched for retractions of studies included in the review. Abstracts of the studies retrieved from the initial search were assessed by an information specialist. Selected studies were then sent to the contributor for additional assessment, using pre-determined criteria to identify relevant studies. Study design criteria for inclusion in this review were: published systematic reviews of RCTs and RCTs in any language, at least single blinded for drug interventions, and containing more than 20 people of whom more than 80% were followed up. There was no minimum length of follow-up required to include studies. We excluded all studies described as "open", "open label", or not blinded unless blinding was impossible; for non-drug interventions open and non-blinded studies were included. In addition, we use a regular surveillance protocol to capture harms alerts from organisations such as the FDA and the UK Medicines and Healthcare products Regulatory Agency (MHRA), which are added to the reviews as required. We searched for any RCTs comparing included options in the review versus placebo or versus each other in people with primary Raynaud's, and included all RCTs of sufficient quality. Many RCTs included people with both primary and secondary Raynaud's phenomenon. We excluded RCTs in which less than 50% of people had primary Raynaud's phenomenon, or where the type of Raynaud's was unclear. We also excluded RCTs in which attacks were experimentally induced (e.g. by dipping the hands in cold water) or which did not assess clinical outcomes. Some RCTs compared changes in symptoms from baseline within each treatment group rather than directly comparing outcomes between treatment groups. These have been described in the comment sections. We have performed a GRADE evaluation of the quality of evidence for interventions included in this review (see table ). To aid readability of the numerical data in our reviews, we round percentages up to the nearest whole number. Readers should be aware of this when relating percentages to summary statitics such as RRs and ORs.

Table
GRADE evaluation of interventions for Raynaud’s phenomenon (primary)

Glossary

Low-quality evidence
Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low-quality evidence
Any estimate of effect is very uncertain.

Notes

Disclaimer

The information contained in this publication is intended for medical professionals. Categories presented in Clinical Evidence indicate a judgement about the strength of the evidence available to our contributors prior to publication and the relevant importance of benefit and harms. We rely on our contributors to confirm the accuracy of the information presented and to adhere to describe accepted practices. Readers should be aware that professionals in the field may have different opinions. Because of this and regular advances in medical research we strongly recommend that readers' independently verify specified treatments and drugs including manufacturers' guidance. Also, the categories do not indicate whether a particular treatment is generally appropriate or whether it is suitable for a particular individual. Ultimately it is the readers' responsibility to make their own professional judgements, so to appropriately advise and treat their patients.To the fullest extent permitted by law, BMJ Publishing Group Limited and its editors are not responsible for any losses, injury or damage caused to any person or property (including under contract, by negligence, products liability or otherwise) whether they be direct or indirect, special, incidental or consequential, resulting from the application of the information in this publication.

Notes

Raynaud's phenomenon (secondary)

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2008; 2008: 1119.
Published online 2008 December 16.

Nifedipine

Summary

ISCHAEMIC ATTACKS Compared with placebo: Nifedipine may reduce the frequency and severity of Raynaud's attacks in people with primary Raynaud's phenomenon ( very low-quality evidence ). ADVERSE EFFECTS Nifedipine is associated with adverse effects including flushing, headache, oedema, and tachycardia.

Benefits

Nifedipine versus placebo:

We found one systematic review (search date 2003; see comment below). Most RCTs identified by the review also included people with a diagnosis other than primary Raynaud's phenomenon. In such cases, the review included the RCT if a subset of people with primary Raynaud's phenomenon could be identified separately and their outcome assessed independently, or if more than 75% of people had primary Raynaud's. The review included 13 RCTs comparing nifedipine versus placebo, of which 11 RCTs were crossover in design. Most RCTs were small, and the number of people included in each RCT with primary Raynaud's phenomenon ranged from three to 130 people (8 RCTs included 21 people or fewer with primary Raynaud's). The review found that nifedipine significantly reduced both the frequency and severity of ischaemic attacks compared with placebo (frequency of ischaemic attacks: 10 RCTs, absolute numbers not provided, WMD –6.05, 95% CI –0.19 to –11.19, P = 0.04; severity [measured on a 10 cm visual analogue scale]: 5 RCTs, absolute numbers not reported, WMD –1.81, 95% CI –0.54 to –3.08, P = 0.005). It found that nifedipine significantly improved ischaemic attacks measured on a 5-point scale compared with placebo (scale not further defined: WMD –1.11, 95% CI –0.85 to –1.38). The review noted that most RCTs included people with or without primary Raynaud's phenomenon, so the meta-analysis could be regarded as a subset analysis of the original RCTs, which could be biased if randomisation was not stratified in people with primary Raynaud's. It also noted that most RCTs were small, crossover in design, and did not report pre-crossover results. Results after crossover may not allow for confounding factors such as inadequate washout, and the naturally variable course of Raynaud's phenomenon.

Harms

The review did not report on harms in the included RCTs. The six largest RCTs included in the review included data on adverse effects. The first RCT found that significantly more people taking nifedipine compared with placebo had oedema (24% with nifedipine v 0% with placebo; P less than 0.01) or flushing (8% with nifedipine v 0% with placebo; P less than 0.01). Two people taking nifedipine had tachycardia. The second RCT found that 10/22 (45%) people taking nifedipine 10 mg, 16/22 (72%) people taking nifedipine 20 mg, and 6/22 (27%) people taking placebo had adverse effects (CI not reported). The third RCT found no significant difference between nifedipine and placebo in the overall incidence of adverse effects, but found that nifedipine significantly increased the risk of palpitations (7/18 [39%] with nifedipine v 1/18 [56%] with placebo; P less than 0.05). The fourth RCT found that significantly more people had adverse effects, including headaches, flushing, and ankle swelling over 8 weeks after crossover with nifedipine compared with placebo (14/23 [61%] with nifedipine v 2/23 [9%] with placebo; P = 0.05). The fifth RCT found that 16/21 (76%) people had adverse effects with nifedipine, but did not report adverse effects with placebo. The sixth RCT (34 people) found that more people had adverse effects, including flushing, headache, and oedema, with nifedipine over 12 weeks after crossover compared with placebo (26/34 [76%] with nifedipine v 5/34 [15%] with placebo; P value not reported).

Comment

The review included RCTs with a drop-out rate of up to 35%. It noted that many of the included RCTs were of short duration (median 2 weeks, range 1−10 weeks) and used relatively low doses of nifedipine. The review also compared calcium channel blockers as a group versus placebo. The meta-analysis included 12 RCTs of nifedipine, two RCTs of nisoldipine, two RCTs of nicardipine, and one RCT of diltiazem. It found that calcium channel blockers as a group significantly reduced the frequency and the severity of attacks compared with placebo (frequency of ischaemic attacks: 17 RCTs, WMD –2.08, 95% CI –1.70 to –3.90; severity [measured on a 10 cm visual analogue scale]: 8 RCTs, WMD –1.39, 95% CI –0.58 to –2.20). However, the majority of the RCTs included in this analysis involved nifedipine.

Clinical guide:

The evidence suggests that nifedipine gives some benefit in reducing the frequency, severity, and number of primary Raynaud's attacks.

Substantive changes

No new evidence

2008; 2008: 1119.
Published online 2008 December 16.

Nicardipine

Summary

ISCHAEMIC ATTACKS Compared with placebo: We don't know whether nicardipine is more effective at reducing the frequency or severity of ischaemic attacks at 6–8 weeks in people with primary Raynaud's phenomenon ( very low-quality evidence ).

Benefits

Nicardipine versus placebo:

We found two RCTs. The first RCT (69 people with primary Raynaud's, crossover design, outcomes assessed after crossover; see comment below) found that nicardipine significantly decreased the frequency of attacks over 8 weeks compared with placebo (attacks/week: 4.9 with nicardipine v 5.8 with placebo; mean difference 0.9, 95% CI 0 to 2.2; P = 0.02) and reduced overall disability (measured on a visual analogue scale of 10 cm, where 0 represented no disability; mean 2.6 with nicardipine v 3.3 with placebo; P = 0.018), but found no significant difference in the severity of attacks (measured on a scale of 1–4, where 1 represented mild and 4 highly severe; 1.36 with nicardipine v 1.55 with placebo; mean difference in severity 0.2, 95% CI 0 to 0.4; P reported as non-significant; no further data reported). The second RCT (25 people, 16 with primary Raynaud's phenomenon, crossover design, outcomes assessed after crossover; see comment below) found no significant difference in the frequency, severity, or duration of attacks at 6 weeks between nicardipine 30 mg twice daily and placebo (analysis in 16 people with primary Raynaud's; mean frequency 4.4 attacks/day with nicardipine v 4.4 attacks/day with placebo; mean severity of attacks on a 10-point scale, where 0 represented no pain; 3.5 with nicardipine v 3.7 with placebo; mean duration of attacks 13 minutes with nicardipine v 11 minutes with placebo; reported as non-significant for all outcomes; no further data reported). The RCT is likely to have been too small to detect a clinically important difference in outcomes.

Harms

Nicardipine versus placebo:

The first RCT found that 7/69 (10%) people withdrew from the trial because of adverse effects: five people taking nicardipine and two taking placebo. In the second RCT, three people withdrew because of adverse effects (including flushing, headache, and palpitations): two taking nicardipine, and one taking placebo.

Comment

The second RCT included nine people with secondary Raynaud's phenomenon. The results of the crossover trials should be viewed with caution as no pre-crossover results were available, and results may not allow for confounding factors such as inadequate washout, and the naturally variable course of Raynaud's phenomenon.

Clinical guide:

Nicardipine has been less well studied in primary Raynaud's phenomenon than nifedipine, but it may decrease the frequency of Raynaud's attacks.

Substantive changes

No new evidence

2008; 2008: 1119.
Published online 2008 December 16.

Amlodipine

Summary

We found no clinically important results about the effects of amlodipine in people with primary Raynaud's phenomenon.

Benefits

We found no RCTs that provided between-group comparisons of amlodipine versus placebo (see comment below).

Harms

We found no RCTs of sufficient quality (see comment below).

Comment

We found one RCT that presented within-group comparisons of changes in outcomes from baseline (24 people, 15 with primary Raynaud's phenomenon, crossover design, outcomes assessed after crossover). It found that amlodipine significantly reduced the number of acute attacks a week from baseline at 7 weeks (from 11.8 attacks/week at baseline to 8.6 attacks/week after treatment; P less than 0.001) and reduced the severity of attacks from baseline (from a discomfort score of 7.8 at baseline to 5.1 after treatment). However, the RCT did not assess the significance of the difference in frequency and severity of attacks between groups. It found that amlodipine was associated with ankle oedema (55% of people taking amlodipine v 0% of people taking placebo), flushing, and headaches compared with placebo (10–20% with amlodipine v 0% with placebo). The RCT included people with secondary Raynaud's phenomenon, so results may not be applicable in people with primary Raynaud's phenomenon.

Clinical guide:

We cannot necessarily generalise the benefits of dihydropyridine calcium channel blockers such as nifedipine to amlodipine, as it has not been primarily studied in RCTs solely in the treatment of primary Raynaud's phenomenon.

Substantive changes

No new evidence

2008; 2008: 1119.
Published online 2008 December 16.

Diltiazem

Summary

ISCHAEMIC ATTACKS Compared with placebo: Diltiazem may reduce the frequency and duration of ischaemic attacks at 8 weeks in people with primary Raynaud's phenomenon ( very low-quality evidence ).

Benefits

We found no RCTs that met Clinical Evidence inclusion criteria (see comment below).

Harms

We found no RCTs of sufficient quality (see comment below).

Comment

One crossover RCT (30 people, 19 with primary Raynaud's phenomenon, outcomes assessed after crossover) found that diltiazem significantly reduced the number and duration of attacks over 8 weeks compared with placebo (mean reduction in attacks from baseline 22.9/month with diltiazem v 4.6/month with placebo; P = 0.01; mean reduction in duration from baseline 444 minutes/month with diltiazem v 160 minutes/month with placebo; P less than 0.01). The results of this RCT should be interpreted with caution as it reported comparisons from baseline, thus removing the benefits of randomisation, and analysis was not by intention to treat (8/30 [27%] people withdrew from the trial). Two people withdrew from the trial because of adverse effects (rash or headache) while taking diltiazem. The RCT included people with secondary Raynaud's phenomenon, so results may not be fully applicable in people with primary Raynaud's phenomenon.

Substantive changes

No new evidence

2008; 2008: 1119.
Published online 2008 December 16.

Naftidrofuryl oxalate

Summary

ISCHAEMIC ATTACKS Compared with placebo: Naftidrofuryl oxalate may reduce the duration and intensity of Raynaud's attacks at 2 months in people with primary Raynaud's phenomenon ( low-quality evidence ).

Benefits

We found one RCT (102 people, 87 with primary Raynaud's phenomenon) comparing naftidrofuryl oxalate 600 mg daily versus placebo for 2 months. It found that, compared with placebo over 2 months, naftidrofuryl oxalate significantly reduced the duration of attacks (P less than 0.05), intensity of attacks (P less than 0.001), and impact of attacks on daily activities (P less than 0.05).

Harms

The RCT found no adverse effects associated with naftidrofuryl oxalate.

Comment

The RCT included people with secondary Raynaud's phenomenon, so results may not be applicable in people with primary Raynaud's phenomenon. The RCT demonstrated a reduced impact of attacks on daily activities. This outcome measurement was not used in other trials, so we cannot compare the relative benefits of this treatment option compared with other drugs in the treatment of primary Raynaud's.

Clinical guide:

Naftidrofuryl oxalate is not routinely used to treat Raynaud's phenomenon.

Substantive changes

No new evidence

2008; 2008: 1119.
Published online 2008 December 16.

Inositol nicotinate

Summary

ISCHAEMIC ATTACKS Compared with placebo: Inositol nicotinate may reduce the frequency and duration of ischaemic attacks at 12 weeks in people with primary Raynaud's phenomenon ( very low-quality evidence ).

Benefits

We found two RCTs. The first RCT (23 people with primary Raynaud's phenomenon) compared inositol nicotinate (4 g daily) versus placebo for 84 days during the winter. It found that, compared with placebo, people taking inositol nicotinate had fewer and shorter attacks over 84 days, but the difference was not significant (P reported as non-significant; no further data reported). The RCT is likely to have been too small to detect a clinically important difference. The second RCT (65 people, 54 with primary Raynaud's phenomenon) found that, compared with placebo, more people taking inositol nicotinate 2 g twice daily improved over 12 weeks (as measured by a 5-point scale from 0 [no problem] to 5 [very severe]), but the difference was not significant (19/34 [56%] people scored 0–1 with inositol v 11/33 [33%] with placebo; RR 1.58, 95% CI 0.90 to 2.76; calculated from data in the paper; see comment below).

Harms

The first RCT found no adverse effects associated with inositol nicotinate. In the second RCT, three people taking inositol nicotinate withdrew from the trial because of gastrointestinal disturbance or dizziness, compared with one person taking placebo.

Comment

The second RCT included people with secondary Raynaud's phenomenon, so results may not be fully applicable in people with primary Raynaud's phenomenon. These data are insufficient to draw any conclusions.

Clinical guide:

Inositol is not usually used for the treatment of primary or secondary Raynaud's phenomenon.

Substantive changes

No new evidence

2008; 2008: 1119.
Published online 2008 December 16.

Prazosin

Summary

ISCHAEMIC ATTACKS Compared with placebo: Prazosin may reduce the number and duration of attacks at 6 weeks, but may not reduce the severity of attacks ( very low-quality evidence ). ADVERSE EFFECTS Prazosin is associated with palpitations and dizziness.

Benefits

We found one RCT (24 people, 14 with primary Raynaud's phenomenon, crossover design, outcomes assessed after crossover; see comment below) comparing prazosin (1 mg twice daily) versus placebo. It found that, compared with placebo, prazosin significantly reduced the mean number and duration of attacks over 6 weeks after crossover (attacks/day: 2.5 with prazosin v 4.1 with placebo; P = 0.003; duration of attacks: 21.9 minutes with prazosin v 29.9 minutes with placebo; P = 0.02), but found no difference in the severity of attacks (measured on a 10-point scale, where 0 represented no pain; 4.1 with prazosin v 4.8 with placebo; P = 0.11).

Harms

The RCT found that 50% of people taking prazosin had adverse effects, including dizziness and palpitations, compared with 29% of people taking placebo.

Comment

The results of the RCT should be viewed with caution as no pre-crossover results were available, and results may not allow for confounding factors such as inadequate washout, and the naturally variable course of Raynaud's phenomenon. The RCT included people with secondary Raynaud's phenomenon, so results may not be fully applicable in people with primary Raynaud's phenomenon.

Clinical guide:

The common adverse effects of prazosin may outweigh any benefits in treating primary Raynaud's phenomenon in most people. Because of this, prazosin is rarely used in the treatment of Raynaud's phenomenon.

Substantive changes

No new evidence

2008; 2008: 1119.
Published online 2008 December 16.

Moxisylyte (thymoxamine)

Summary

We found no clinically important results about the effects of moxisylyte (thymoxamine) in people with primary Raynaud's phenomenon.

Benefits

We found no RCTs of moxisylyte that assessed clinical outcomes.

Harms

We found no RCTs of sufficient quality.

Comment

Clinical guide:

In general, thymoxamine is not used in the treatment of primary Raynaud's phenomenon.

Substantive changes

No new evidence

2008; 2008: 1119.
Published online 2008 December 16.

Keeping warm

Summary

We found no clinically important results about the effects of keeping warm in people with primary Raynaud's phenomenon. NOTE There is consensus that keeping warm helps prevent Raynaud's attacks and most clinicians recommend it.

Benefits

We found no RCTs of keeping warm that met Clinical Evidence inclusion criteria.

Harms

We found no RCTs.

Comment

Clinical guide:

Although we found no RCTs of sufficient quality in this area, most clinicians recommend avoiding the cold if possible to prevent Raynaud’s attacks.

Substantive changes

Keeping warm No RCTs added. Categorisation changed (Likely to be beneficial; by consensus) as most clinicians recommend avoiding the cold if possible to prevent Raynaud’s attacks.

2008; 2008: 1119.
Published online 2008 December 16.

Exercise

Summary

We found no clinically important results about the effects of exercise in people with primary Raynaud's phenomenon.

Benefits

We found no RCTs.

Harms

We found no RCTs.

Comment

Clinical guide:

It is uncertain what effect exercise would have on primary Raynaud's phenomenon.

Substantive changes

No new evidence

2008; 2008: 1119.
Published online 2008 December 16.

Smoking cessation

Summary

We found no clinically important results about the effects of smoking cessation in people with primary Raynaud's phenomenon.

Benefits

We found no RCTs.

Harms

We found no RCTs.

Comment

Clinical guide:

It is uncertain what effect smoking cessation would have on Raynaud's phenomenon.

Substantive changes

No new evidence


Articles from BMJ Clinical Evidence are provided here courtesy of BMJ Publishing Group