{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T15:17:24Z","timestamp":1789917444749,"version":"4.0.1"},"reference-count":36,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2017,6,26]],"date-time":"2017-06-26T00:00:00Z","timestamp":1498435200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100007819","name":"Allergan","doi-asserted-by":"publisher","award":["IIT\u201000696"],"award-info":[{"award-number":["IIT\u201000696"]}],"id":[{"id":"10.13039\/100007819","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001600","name":"Research and Education Foundation, Sligo General Hospital","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001600","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arthritis &amp; Rheumatology"],"published-print":{"date-parts":[[2017,8]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To assess the therapeutic efficacy of local injections of botulinum toxin type A (Btx\u2010A) in improving blood flow to the hands of patients with Raynaud's phenomenon (RP) secondary to scleroderma.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this randomized, double\u2010blind, placebo\u2010controlled clinical trial, patients with scleroderma\u2010associated RP received Btx\u2010A (50 units in 2.5 ml sterile saline) in one randomly selected hand and sterile saline (2.5 ml) in the opposite hand. Follow\u2010up at 1 and 4 months postinjection included laser Doppler imaging of hands, patient\u2010reported outcomes, and physical examination. We compared outcomes using paired <jats:italic>t<\/jats:italic>\u2010tests and population\u2010average generalized models with generalized estimating equations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 40 patients enrolled, 25 had limited scleroderma and 15 had diffuse scleroderma. From baseline to 1\u2010month follow\u2010up, there was a greater reduction in average blood flow in Btx\u2010A\u2013treated hands compared to placebo\u2010treated hands. The model estimated that this difference was statistically significant (average difference \u221230.08 flux units [95% confidence interval \u221256.19, \u22123.98], <jats:italic>P<\/jats:italic> for interaction\u2009=\u20090.024). This difference was mainly influenced by patients with longstanding RP and diffuse scleroderma. Change in blood flow at 4\u2010month follow\u2010up was not significantly different between groups. Clinical measures (QuickDASH, McCabe Cold Sensitivity Score, pain on a visual analog scale, and Raynaud's Condition Score) improved slightly for Btx\u2010A\u2013treated hands.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our laboratory\u2010based laser Doppler imaging flow data do not support using Btx\u2010A to treat RP in all scleroderma patients. The secondary clinical outcomes suggest some positive effect, but its clinical meaningfulness is questionable. The role of Btx\u2010A in treating RP should be further studied with more homogeneous patient populations and in unique clinical situations such as acute digital ischemia.<\/jats:p><\/jats:sec>","DOI":"10.1002\/art.40123","type":"journal-article","created":{"date-parts":[[2017,4,20]],"date-time":"2017-04-20T15:50:37Z","timestamp":1492703437000},"page":"1661-1669","source":"Crossref","is-referenced-by-count":106,"title":["The Therapeutic Efficacy of Botulinum Toxin in Treating Scleroderma\u2010Associated Raynaud's Phenomenon: A Randomized, Double\u2010Blind, Placebo\u2010Controlled Clinical Trial"],"prefix":"10.1002","volume":"69","author":[{"given":"Ricardo J.","family":"Bello","sequence":"first","affiliation":[{"name":"Johns Hopkins University Baltimore Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carisa M.","family":"Cooney","sequence":"additional","affiliation":[{"name":"Johns Hopkins University Baltimore 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