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. 2021 Jul 14;61(4):1476–1486. doi: 10.1093/rheumatology/keab537

Table 3.

Recommendations on patient education and treatments for systemic sclerosis patients with RP and/or digital ulcers

Level of Evidence Reference Level of Agreement (0–10) Mean (s.d.); Median (range)
PATIENT EDUCATION
All SSc patients with problems due to Raynaud’s phenomenon and/or digital ulcers should receive patient education about the following aspects.
21. Quitting smoking. IV [50] 9.4 (0.9) 10 (7–10)
22. Avoiding triggers that can elicit an attack of Raynaud's, such as sudden changes in temperature, drinking large amounts of coffee or energy drinks, and stress. V [50] 9.0 (1.2) 9.0 (5–10)
23. Practical advice for protection against cold and avoiding temperature differences:

  1. use of special clothing, silver gloves, heated gloves, or heating pads;

  2. drying the skin thoroughly after showering or washing hands;

  3. (iii) avoiding contact with cold objects (wearing gloves to remove items from the fridge/freezer, using a heated keyboard and mouse).

 IV [50] 8.9 (1.1) 9 (6–10)
24. Wearing fingertip protection (e.g. thermoplastic material or neoprene) to prevent pain when performing actions that cannot be avoided. V n/a 7.8 (1.9) 8 (3–10)
25. Preventing infections and wounds through good hygiene, avoiding bruising and hazardous work, and using gloves for protection. V n/a 8.7 (1.7) 9 (3–10)
26. Promoting good blood circulation through the use of a stress ball and having sufficient exercise throughout the day. V n/a 7.4 (2.3) 8 (1–10)
27. Avoiding prolonged, static postures. V n/a 7.3 (2.2) 8 (1–10)
In SSc patients with digital ulcers, attention should also be paid to the following aspects.
28. Hydration of the skin around the ulcers with products based on lanolin, petroleum jelly or cetomacrogol. IV [48] 8.0 (1.6) 8 (4–10)
29. Avoiding frequent exposure to water with aggressive cleaning agents. IV [48] 8.1 (1.7) 8 (3–10)
30. Avoiding finger punctures. V n/a 8.0 (1.8) 8 (4–10)
31. Avoiding manipulation of ulcers (e.g. by squeezing out calcium deposits or cutting away hard skin). V n/a 8.3 (1.9) 9 (4–10)
TREATMENTS
Treatments for SSc patients whose activities of daily living are restricted due to Raynaud’s phenomenon and/or digital ulcers.
32. Exercise therapy (with an arm bicycle) to promote general blood circulation and support the integration of exercise activities in daily life, guided by a health professional (e.g. a physiotherapist), should be offered to SSc patients with Raynaud's phenomenon/digital ulcers. III [51] 7.4 (1.7) 8 (2–10)
33. In case of vasculopathy of the feet, advice about suitable, non-restrictive footwear (for indoor and outdoor use), by a health professional such as, for example, a podiatrist, should be offered to SSc patients. V n/a 7.8 (1.9) 8 (1–10)
34. Advice on the protection of the fingertips with special gloves or by using adaptive devices, provided by a health professional (e.g. an occupational therapist), should be offered to SSc patients whose activities of daily living are restricted due to Raynaud's phenomenon/digital ulcers. V n/a 8.2 (1.7) 9.0 (3–10)

Level of evidence (according to the standards of the Oxford Centre for Evidence Based Medicine), Level of Agreement for the recommendations, Numeric Rating Scale from 0 (total disagreement) to 10 (total agreement) reported as mean (range), n/a not applicable.