Raynaud Phenomenon

Screening Questions

• Ask the following screening questions: • Are your fingers unusually sensitive to cold? • Do your fingers change color when they are exposed to cold temperatures? • Do they turn white, blue, or both?
• The diagnosis of Raynaud's phenomenon is confirmed by a positive response to all three questions.
• The diagnosis of Raynaud's phenomenon is excluded if the responses to questions 2 and 3 are negative.

Exclude potential causative or aggravating factors

• • Occupational and environmental factors: Polyvinyl chloride, frostbite, hand-arm vibration, and hypothenar hammer syndrome
• • Drugs: Chemotherapeutic agents, interferon, estrogen, nicotine, narcotics, sympathomimetic agents, ergotamines, β-blockers (nonselective), clonidine
• • Neuropathy: Carpal tunnel syndrome

Normal medical history and physical examination

• Normal medical history and physical examination (no digital lesions or gangrene, normal nail-fold capillaries): Patients do not need to undergo specialized studies and can be considered to have primary Raynaud's phenomenon.

History suggestive of obstructive vascular disease

• History of single digit - asymmetric attacks, absent peripheral pulses, asymmetry of blood pressure, or evidence of critical ischemia: Patients should undergo arterial Doppler ultrasonography, MRI/MRA, or angiography.
• Abnormal findings indicate presence of obstructive vascular disease: • Atherosclerosis • Thromboangiitis obliterans • Embolic disease • Thoracic outlet syndrome

Symptoms or signs suggestive of systemic disease

• Symptoms or signs suggestive of systemic disease (myalgias, arthralgias, fever, weakness, weight loss, rash, arthritis, sicca syndrome, or symptoms of heart or lung disease) with or without abnormal nail-fold capillaries: Patients should undergo the following studies: • Complete blood cell count • General blood chemical analyses • Urinalysis • Test for anti-nuclear antibodies • Test for rheumatoid factor • Test for disease-specific autoantibodies • C3 and C4 complement levels
• Patients with positive results have rheumatic disease: • Scleroderma • Systemic lupus erythematosus • Mixed connective-tissue disease • Dermatomyositis • Polymyositis • Sjögren's syndrome • Vasculitis • Anti-phospholipid syndrome • Undifferentiated CTD
• Patients with negative results should have the following studies: • Thyroid-function test • Serum protein electrophoresis • Test for cryoglobulins and cryofibrinogen
• Patients with positive results have other systemic diseases: • Hypothyroidism • Cancer • Cold agglutinin syndrome • POEMS syndrome • Cryoglobulinemia • Cryofibrinogenemia • Hyperviscosity syndrome