Do you recommend vasodilators in patients with Raynaud's who have capillary drop out but are otherwise not bothered enough by their symptoms to want to pursue systemic treatment?

I typically do not unless they have had ischemic events in the past (like pitting or ulcers). Unfortunately, we do not have good longitudinal data to support the idea that prophylactically treating patients with vasodilators when they are otherwise minimally symptomatic will have a preventative role...

Vasodilator therapy for Raynaud’s phenomenon (RP) is primarily aimed at reducing the frequency and duration of vasospastic attacks, thereby improving symptoms. For this reason, nailfold capillary abnormalities in the absence of significant RP symptoms do not currently justify initiating treatment, a...

If patients find their RP symptoms manageable, then I do not usually start vasodilators purely on account of the level of capillary drop out. The principle aim of treatment is to help with symptoms, and we do not yet have a strong enough evidence base to justify such treatments for disease modificat...