Clinical Observation Of Botulinum Toxin Type A In The Treatment Of Raynaud’s Phenomenon

Objectives:Raynaud’s phenomenon(RP)is a nonspecific clinical manifestation of recurrent spasms in peripheral vessels under the action of stimulation.The affected fingers have significant cold feeling,and RP’s typical clinical picture is an unique kind of skin changes called "three-phase color".RP may be accompanied by paresthesia,and patients can have limb ulcer or gangrene in severe cases.They tend to occur in young and middle-aged women.Because of the lack of understanding of the disease,patients often have a long course of disease before treatment.Affected by the disease,the work and life of patients are faced with serious trouble.According to different etiologies,it can be divided into the primary RP and the secondary RP.There is little discussion on the pathogenesis of the primary RP,and the secondary RP may be related to other diseases,mainly connective tissue diseases.Although new advances has been discovered in the research of RP,the pathogenesis of RP has not been fully elaborated.Because this disease still cannot be cured completely with present medical treatment means,all sorts of treatment plans are in order to improve symptom and prevent attacks.Botulinum toxin type A(BTX-A)has been successfully treated in patients with RP,but there are few domestic articles about BTX-A injection for patients with RP.Therefore,in this study,we observed the effectiveness of BTX-A in the treatment of domestic patients with RP,and its purpose is to provide a new reference scheme for the clinical treatment of RP.Methods:Eleven patients with RP who agreed to use BTX-A were selected.Clinical stage and subjective score were performed according to the patient’s symptoms before treatment.Nine points were selected on the palm surface of patients with RP according to the nine-point method,and the injection dose was 2.5U/point for each patient.Follow-up 2 weeks and 4 weeks after treatment and grade it again.Evaluation criteria for efficacy of Taylor-Pelmear staging:(1)near-term recovery: no seizure(X→0);(2)Effective: reduced scope of involvement,reduced frequency of attack or reduced severity(4→3/2/1 or 3→2/1 or 2→1);(3)Invalid: no change(X→X).Total effective proportion =(near-term recovery + effective)cases/number needed to treat.SPSS 25 was selected for data analysis,and repeated measurement analysis of variance was selected for the data of clenched hand test.The rank sum test was selected for Taylor-Pelmear staging and VAS score,and the data were represented by median and quartile.The difference was statistically significant when P-value is less than 0.05.Results:Overall,the majority of patients experienced subjective relief of symptoms within 48-72 hours after BTX-A treatment,including changes in skin color,reduction in pain,and reduction in swelling.During follow-up,the duration of the clenched hand test was shortened,the VAS score decreased,and the Taylor-Pelmear staging reduced.Among them,2 weeks after treatment,1 case(9.09%)was ineffective,8 cases(72.73%)were effective,and 2 cases(18.18%)were cured recently.Four weeks after BTX-A injection,2 patients who had responded to the treatment turned to near-term recovery.The total effective proportion was 90.91% after 4 weeks of follow-up.No adverse reactions were reported during the follow-up.During follow-up,the mean duration of the clenched hand test was shortened and the VAS score was decreased,and the Taylor-Pelmear staging improved,with statistically significant differences compared with pre-treatment(P<0.05).Conclusion:1.The proportion of female patients in this study was relatively high.2.It has been confirmed that Botulinum toxin type A injection is a kind of effective cure for Raynaud’s phenomenon,and can significantly relieve the severity and frequency of attacks in patients.3.Botulinum toxin type A is relatively safe in the treatment of Raynaud’s phenomenon,with no obvious toxic and side effects.