Managing the Ischemic Finger in Scleroderma

The patient is a 48-year-old Caucasian woman with limited scleroderma. The features of her disease include stiff puffy fingers, gastrointestinal reflux disease (GERD), severe Raynaud’s phenomenon (RP), and sicca syndrome. On her initial examination, the blood pressure was 120/69, weight 130 lb., pulse 79, temperature 98°, and normal respiratory rate. Sclerodactyly, numerous cutaneous telangiectasia on the palms and face and definite abnormal nailfold capillaries with dilatation and areas of loss of capillaries were noted. The remainder of her examination was completely normal. The general laboratory testing was unremarkable but serology demonstrated high-titer anti-centromere antibodies. Both lung function testing and echocardiograph were normal. She was managed with a proton pump inhibitor for her GERD and artificial tears for her dry eyes. Suddenly, she presents with a painful ischemic finger despite the use of a calcium channel blocker that had improved the severity of RP.