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Severe digital ischaemia treated with phosphodiesterase inhibitors
  1. C R Kumana,
  2. G T Y Cheung,
  3. C S Lau
  1. Department of Medicine, The University of Hong Kong, 8/F Administration Block, Queen Mary Hospital, Hong Kong
  1. Correspondence to:
    Professor C S Lau
    cslauhkucc.hku.hk

https://doi.org/10.1136/ard.2003.015677

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    Pulmonary hypertension is associated with autoimmune diseases, giving rise to digital ischaemia, including Raynaud’s phenomenon (RP). As sildenafil, a phosphodiesterase-5 (PDE-5) inhibitor, relieves the pulmonary hypertension,1 we suggested that it might also benefit digital ischaemia and RP symptoms. This report describes the impact of oral sildenafil (Viagra, donated by Pfizer HK) on three women with autoimmune disease and progressively severe digital ischaemia, despite treatment with a variety of drugs, including intravenous iloprost (fig 1). All patients gave written informed consent to try this off-label treatment.

    Figure 1

     (A), (B), and (C) refer to cases 1, 2, and 3, respectively. In all three cases, ischaemia of viable tissues resolved after treatment with sildenafil (and tadalafil in case 2). (B) shows that increased finger extension became possible after treatment.

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