From the Guidelines
Raynaud's phenomenon is diagnosed primarily through a clinical evaluation by a healthcare provider, including a detailed medical history and physical examination, as well as specific diagnostic procedures such as cold stimulation test, nailfold capillaroscopy, and blood tests to check for underlying conditions 1. To diagnose Raynaud's, the following steps should be undertaken:
- A detailed medical history, focusing on symptoms such as fingers or toes changing color in response to cold or stress
- A physical examination, looking for skin changes and checking nails for abnormalities
- A cold stimulation test, where hands are exposed to cold water to trigger symptoms
- Nailfold capillaroscopy to examine the small blood vessels near fingernails
- Blood tests, such as a complete blood count, antinuclear antibody test, and erythrocyte sedimentation rate, to check for underlying conditions like autoimmune disorders 1 Key considerations in diagnosis include:
- Classifying Raynaud's as primary (idiopathic) when no underlying cause is found, or secondary when it's associated with another condition
- Recognizing that early diagnosis is important because Raynaud's can sometimes be an early sign of a more serious connective tissue disorder, particularly if symptoms begin after age 30 or are severe
- Avoiding known Raynaud phenomenon triggers, such as cold, trauma, stress, smoking, vibration injury, or certain drugs, to reduce the frequency and severity of attacks 1
From the Research
Diagnosis of Raynaud's Phenomenon
To diagnose Raynaud's phenomenon, the following steps can be taken:
- A thorough history and physical examination are essential to determine the extent of the diagnostic workup 2
- A detailed clinical history and careful physical examination may be helpful in identifying the cause of Raynaud's phenomenon 3
- Routine investigations include:
- Full blood count
- Measurement of erythrocyte sedimentation rate
- C-reactive protein
- Antinuclear antibody levels
- Biochemical profile
- Thyroid function tests
- Protein electrophoresis
- Chest X-ray
- Nailfold capillaroscopy 3
- Nailfold capillaroscopy plays a leading role in the assessment of Raynaud's phenomenon patients, providing opportunities for morphological assessment of capillaroscopic findings in the nailfold area 4
- Digital photoplethysmography and pulse contour analysis can be used as an additional tool to exclude structural macro- or microvascular disease 5
- Doppler ultrasound is recommended to evaluate the risk of pathologies in large to medium-sized arteries 3
Differential Diagnoses
The diagnosis of Raynaud's phenomenon can be made on the basis of the patient's clinical symptoms, and differential diagnoses include:
- Primary Raynaud's phenomenon, which occurs without underlying disease and is considered a benign condition 5
- Secondary Raynaud's phenomenon, which is associated with other diseases, mainly connective tissue diseases such as systemic sclerosis 3, 5
- Acrocyanosis and erythromelalgia, which are additional functional vascular disorders that can be easily distinguished when patients are carefully assessed for their history and clinical symptoms 5
- Systemic sclerosis (SSc) or other connective tissue diseases, which can be suspected based on clinical findings, laboratory tests, and immunological results 3, 4
Classification and Diagnostic Criteria
The classification of Raynaud's phenomenon is based on the presence or absence of underlying disease, and diagnostic criteria include:
- Normal erythrocyte sedimentation rate
- Negative testing for antinuclear antibodies
- Normal nailfold capillaries
- Absence of structural micro- or macrovascular damage and other diseases 5
- Abnormal "scleroderma" type capillaroscopic pattern, which has been established as a new classification criterion for systemic sclerosis (SSc) in 2013 4