{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,25]],"date-time":"2025-07-25T10:36:45Z","timestamp":1753439805668},"reference-count":64,"publisher":"Sociedade Portuguesa de Reumatologia","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["ARP Rheumatol"],"abstract":"<jats:p>Objective: To develop evidence-based recommendations for the non-pharmacological and pharmacological management of Raynaud\u2019s phenomenon (RP) and digital ulcers (DUs) in patients with systemic sclerosis and other immune- mediated connective tissue diseases (CTDs). Methods: A task force comprising 21 rheumatologists, 2 surgeons (vascular and plastic), 2 nurses, and 1 patient representative was established. Following a systematic literature review performed to inform the recommendations, statements were formulated and discussed during two meetings (one online and one in-person). Levels of evidence, grades of recommendation (GoR), and level of agreement (LoA) were determined. Results: Five overarching principles and 13 recommendations were developed. GoR ranged from A to D. The mean \u00b1 standard difference (SD) LoA with the overarching principles and recommendations ranged from 7.8\u00b12.1 to 9.8\u00b10.4. Briefly, the management of RP and DUs in patients with CTDs should be coordinated by a multidisciplinary team and based on shared decisions with patients. Nifedipine should be used as first-line therapy for RP and\/ or DUs. Sildenafil, tadalafil, and\/or iloprost IV are second-line options for severe and\/or refractory patients with RP and\/or DUs. Sildenafil, tadalafil and\/or Iloprost IV, should be prescribed for healing and prevention (also including bosentan) of DUs. In patients with RP and\/or DUs, non-pharmacological interventions might be considered as add-ons, but there is limited quality and quantity of scientific evidence supporting their use. Conclusions: These recommendations will inform rheumatologists, specialist nurses, other healthcare professionals, and patients about a comprehensive and personalized management of RP and DUs. A research agenda was developed to address unmet needs, particularly for non-pharmacologic interventions.<\/jats:p>","DOI":"10.63032\/ylkm7405","type":"journal-article","created":{"date-parts":[[2024,6,30]],"date-time":"2024-06-30T08:19:32Z","timestamp":1719735572000},"page":"84-94","source":"Crossref","is-referenced-by-count":3,"title":["Portuguese Recommendations for the management of Raynaud\u2019s phenomenon and digital ulcers in systemic sclerosis and other connective tissue diseases"],"prefix":"10.63032","volume":"3","author":[{"name":"Rheumatology Department, Unidade Local de Sa\u00fade de Coimbra - Centro Hospitalar e Universit\u00e1rio de Coimbra, Coimbra, Portugal","sequence":"first","affiliation":[]},{"given":"T","family":"Santiago","sequence":"first","affiliation":[]},{"name":"Faculty of Medicine, Coimbra University","sequence":"additional","affiliation":[]},{"given":"AC","family":"Duarte","sequence":"additional","affiliation":[]},{"name":"Rheumatology Department, Unidade Local de Sa\u00fade Almada- Seixal - Hospital Garcia de Orta, Almada, Portugal","sequence":"additional","affiliation":[]},{"given":"A","family":"Sepriano","sequence":"additional","affiliation":[]},{"name":"Rheumatology Department, Hospital de Egas Moniz, Unidade Local de Sa\u00fade de Lisboa Ocidental, Lisboa, Portugal; 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