Inclusion Criteria:  Age 18 or older Patients with moderate to severe RP that is not controlled after 3 months of standard medical therapy as prescribed by a Rheumatologist, or severe RP with evidence of tissue loss.  Exclusion Criteria:  Patients under the age of 18 Patients who have previously undergone treatment with BT for RP within the past year Patients with active infection at the treatment site (active infection defined as cellulitis, purulence, fever, chills, or presence of elevated inflammatory markers, ie. WBC, ESR, CRP) Patients who have undergone prior digital sympathectomy surgery for RP Patients who have recently altered their medical regimen for RP within the past 4 weeks Patients with allergy or contraindication to BT injection