Botulinum toxin reduces pain, disability in Raynaud’s syndrome secondary to scleroderma
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Key takeaways:
- Injections yielded significant improvements in visual analog scale pain and Quick-DASH score, as well as skin temperature.
- Study design was diverse, highlighting need for ‘core outcome sets.’
Botulinum toxin injections in the hand led to significant reductions in pain and disability for patients with Raynaud’s syndrome secondary to scleroderma, according to data published in Clinical Rheumatology.
“[Botulinum toxins] are an example of neurotoxins produced by Clostridium difficile; its mechanism of action in relation to its use in [Raynaud’s phenomenon] is hypothesized to be via the antagonism of vasoconstriction in arterioles of the digits secondary to blockade of the noradrenaline-mediated sympathetic pathway causing vasodilation, alleviating symptoms of [Raynaud’s phenomenon],” Calver Pang, PhD, of the department of surgical biotechnology at University College London, and colleagues wrote.
“The use of botulinum toxin for treatment of [Raynaud’s phenomenon] was first utilized in 2004,” they added. “Since then, there has been several studies suggesting it could be effective in the management of [Raynaud’s phenomenon]; however, not all studies found conclusive evidence.”
To assess the current state of research into botulinum toxin injections to treat Raynaud’s syndrome secondary to scleroderma, Pang and colleagues conducted a systematic review and meta-analysis of 19 studies, including six randomized, double-blind controlled trials; seven case series; two retrospective chart reviews and four cohort studies.
The studies were published between 2007 and 2022 and consisted of between two and 91 participants. Using a random effects model, the researchers analyzed differences in visual analog scale pain (VAS-P); Quick-DASH, a measurement of upper extremity symptoms and disability; and Raynaud’s condition score, a patient-reported measure of severity.
According to the researchers, botulinum toxin injections produced significant effects on Quick-DASH score (P = .03) and VAS-P score (P < .00001). However, Raynaud’s condition score was not significantly reduced, with an overall P value of .37. The review also found significant increases in skin temperature following injection in fingers impacted by severe Raynaud’s syndrome.
Additionally, the researchers noted “great diversity” between the studies, with variation in doses and injection sites making the data more difficult to evaluate.
“Each study measured most outcomes in different ways, making the development of core outcome sets necessary for future evaluation of the BTX-A use in Raynaud’s and BTX-A techniques,” Pang and colleagues wrote.
Overall, the findings were promising but highlighted gaps requiring further investigation, according to the researchers.
“BTX-A is a therapeutic method shown to solve a significant problem for patients with [Raynaud’s phenomenon] secondary to scleroderma; however, the evidence published so far is not sufficient to credit it as a revolutionary first-line treatment,” they added. “Ongoing clinical trials, such as the one in Emory University Hospital ... are needed to confirm the need for BTX-A in treatment of [Raynaud’s phenomenon].”
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