Botulinum A Toxin Injection as an Adjuvant Wintering Therapy in Patients with Raynaud’s Syndrome

다국어 초록 (Multilingual Abstract)

Purpose: Patients with secondary Raynaud’s syndrome experience severe pain and even ulceration of the fingertips, par-ticularly during the winter season. The aim of this retrospective review was to evaluate whether botulinum A toxin injec-tion before the winter season could prevent severe pain and complications in patients with secondary Raynaud’s syndrome.Methods: Patients (n=10) were injected with botulinum A toxin (25 U) at 14 points on each hand. Sex, age, number of treatments, underlying diseases, pre- and post-injection pain intensity and frequency, satisfaction with the injection, and complications were evaluated. Statistical analyses were performed using the Wilcoxon signed-rank test.Results: All patients had secondary Raynaud’s syndrome and were female, with mean age of 50.1 years. All patients showed an improvement in pain intensity after the injection. The frequency of pain per week improved after the injection in seven patients and remained the same in three patients. The mean satisfaction rating was 7.0 out of 10 points. Eight pa-tients were willing to reinject; however, two patients refused reinjection due to injectional pain. Two patients had tempo-rary weakness of the hand. Seven patients showed an improvement in cyanosis. Nine patients showed an protectiv effects in fingertip ulcerations.Conclusion: Botulinum A toxin injection in patients with secondary Raynaud’s syndrome before the winter season may provide substantial improvements in pain and ulceration, as the pain increases during the cold season. Furthermore, the protective effect of botulinum A toxin may also be helpful in preventing additional surgery.

참고문헌 (Reference)

1 Bello RJ, "The therapeutic efficacy of botulinum toxin in treating scleroderma-associated Raynaud’s phenomenon : a randomized, double-blind, placebo-controlled clinical trial" 69 : 1661-1669, 2017

2 Neumeister MW, "The role of botulinum toxin in vasospastic disorders of the hand" 31 : 23-37, 2015

3 Segreto F, "The role of botulinum toxin A in the treatment of Raynaud phenomenon" 77 : 318-323, 2016

4 Wall LB, "Nonoperative treatment of digital ischemia in systemic sclerosis" 37 : 1907-1909, 2012

5 Neumeister MW, "Minimally invasive treatment of Raynaud phenomenon : the role of botulinum type A" 30 : 17-24, 2014

6 Van Beek AL, "Management of vasospastic disorders with botulinum toxin A" 119 : 217-226, 2007

7 Garrido-Ríos AA, "Ischaemic ulcers on the toes secondary to Raynaud phenomenon in a patient with systemic sclerosis successfully treated with botulinum toxin" 43 : 503-505, 2018

8 Eickhoff JC, "Iatrogenic thenar eminence atrophy after botox a injection for secondary raynaud phenomenon" 22 : 396-397, 2016

9 Ungprasert P, "Epidemiology of mixed connective tissue disease, 1985-2014 : a population-based study" 68 : 1843-1848, 2016

10 Motegi SI, "Efficacy of botulinum toxin B injection for Raynaud’s phenomenon and digital ulcers in patients with systemic sclerosis" 97 : 843-850, 2017

11 Smith L, "Botulinum toxin-A for the treatment of Raynaud syndrome" 148 : 426-428, 2012

12 Neumeister MW, "Botulinum toxin type A in the treatment of Raynaud’s phenomenon" 35 : 2085-2092, 2010

13 Fregene A, "Botulinum toxin type A : a treatment option for digital ischemia in patients with Raynaud’s phenomenon" 34 : 446-452, 2009

14 Iorio ML, "Botulinum toxin A treatment of Raynaud’s phenomenon : a review" 41 : 599-603, 2012

15 Neumeister MW, "Botox therapy for ischemic digits" 124 : 191-201, 2009

16 Uppal L, "A prospective study of the use of botulinum toxin injections in the treatment of Raynaud’s syndrome associated with scleroderma" 39 : 876-880, 2014