Vascular response of Raynaud's phenomenon to nifedipine or herbal medication (duhuo-tisheng tang with danggui-sini tang): a preliminary study.

BACKGROUND: Raynaud's phenomenon (RP) is a common manifestation in connective tissue diseases. Calcium channel antagonists are most effective and frequently used for treating RP. This study compared the efficacy, digital vascular response, and tolerability between nifedipine and a combination of 2 Chinese herbal medications (duhuo-tisheng tang and danggui-sini tang) for treating RP.

METHODS: This open-label non-randomized clinical trial included 47 connective tissue disease patients with RP. The herbal group and the nifedipine group included 26 and 21 patients, respectively. The duration of therapy was 4 weeks. Baseline and posttreatment laser Doppler blood flow imaging of both hands were performed at room temperature and after cold challenge. Nailfold capillary microscopy was performed at the baseline and after 4 weeks of therapy. Serum levels of soluble intercellular adhesion molecule-1 (sICAM-1), prostaglandin E2 (PGE2), nitrite (NO2), and nitrate (NO3), and plasma levels of endothelin-1 (ET-1) were also measured. Self-reported symptoms, using a visual analog scale (VAS) and a physician global assessment (PGA), were recorded at the baseline and after treatment.

RESULTS: After 4 weeks of treatment, VAS scores improved (p = 0.0035) and the physician's global assessment of RP severity decreased in the nifedipine group (p = 0.0078) but not in the herbal group. Episodes of RP attacks decreased in the nifedipine group after treatment (p = 0.008). The nifedipine group had increased laser Doppler flow (116.3 +/- 70.7 AU) compared to the baseline (72.4 +/- 49.0 AU, p = 0.0008). Laser Doppler images improved at various time points after cold challenge in the nifedipine group after therapy. Laser Doppler flow in the herbal group did not significantly change with therapy. Capillary microscopy demonstrated no significant difference in enlargements, avascularity, or hemorrhagic spots between groups. Serum NO2 concentrations were higher in the nifedipine group than in the herbal group. Levels of sICAM-1, PGE2, NO3, and ET-1 after therapy were similar to those at the baseline in both groups.

CONCLUSIONS: The digital vascular response in RP improved with nifedipine but was unchanged with a combination of the Chinese medicines Duhuo-Tisheng Tang and Danggui-Sini Tang.