A retrospective clinical analysis of medical treatments used for symptomatic relief of Raynaud's phenomenon in children at Royal Liverpool Children's Hospital, UK

Background

Literature on treatment of Raynaud's phenomenon (RP) in the paediatric age group is scarce, and practice varies. We completed a retrospective analysis of patients with RP treated by paediatric rheumatologists at Royal Liverpool Children's Hospital to assess clinical response to medical treatments including calcium channel blockers (nifedipine and amlodipine) and Glyceryl trinitrate (GTN) patches.

Methods

Clinic letters and case notes were reviewed. RP was graded as mild, moderate or severe according to frequency and severity of symptoms. Response to treatment was assessed by reduction in symptoms without significant adverse effects.

Results

A total of 45 patients were included in the study of which 42 (32 with primary and 10 with secondary Raynaud's) had sufficient data available for analysis. 14 patients did not receive any medical intervention. 28 patients received one or more medical treatments sequentially over time. GTN patches were used in 18 patients of whom 9 (50%) demonstrated a good response. Three more patients await assessment. Six patients failed to improve, or had adverse effects. Nifedipine was used in 11 patients of whom 4 (36%) showed a good response. Amlodipine was used in 12 patients of whom 3 (25%) showed a good response.

Conclusion

No one treatment option is uniformly efficacious in patients with Raynaud's. GTN patches seem to be effective without significant adverse effects. Amlodipine and nifedipine were useful in smaller percentages of patients. Clinical response was similar in patients with primary and secondary Raynaud's. Responses according to severity of disease are discussed.