A 52-year-old man presents with recurrent episodes of digital pallor followed by cyanosis and erythema upon cold exposure. He has no tissue loss. Antinuclear antibody is negative. Nail-fold capilloscopy is normal. Which is the most appropriate initial pharmacotherapy?

• A Iloprost (prostacyclin analogue)
• B Bosentan (endothelin receptor antagonist)
• C Sildenafil (phosphodiesterase-5 inhibitor)
• D Nifedipine (calcium channel blocker) ✓

Explanation

This is primary Raynaud's phenomenon (no secondary cause, normal ANA, normal capillaroscopy). First-line treatment is lifestyle modifications and a calcium channel blocker (nifedipine). Bosentan is used for digital ulcers in systemic sclerosis. Sildenafil and iloprost are reserved for severe cases with digital ulcers or refractory symptoms not responding to calcium channel blockers. The absence of tissue loss and negative autoimmune markers distinguish primary from secondary Raynaud's.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.