From the Guidelines
The confirmatory test for Raynaud's disease is not explicitly stated as the evidence provided does not directly address the confirmatory test for Raynaud's disease.
Relevant Testing for Raynaud's Phenomenon
- The presence of Raynaud’s phenomenon is considered an uncertain indication for upper extremity arterial testing 1.
- However, upper extremity arterial testing may be considered in patients with symptoms such as claudication, ulcer, unilateral cold painful hand, suspected positional arterial obstruction, and trauma with suspicion of vascular injury 1.
- A preoperative evaluation for a procedure such as radial artery harvest or suspected complication after an upper extremity arterial intervention is also an appropriate indication for testing 1.
Surveillance and Follow-up
- The most appropriate initial surveillance time interval after upper extremity revascularization with either vein or prosthetic bypass graft was at 12 months 1.
- A surveillance period of every 6 months after initial postoperative evaluation was most inappropriate for asymptomatic patients 1.
From the Research
Confirmatory Test for Raynaud's Disease
- The confirmatory test for Raynaud's disease is a cold test that measures cold induced post-ischemic reactive hyperemia 2.
- This test involves immersing the hand in a stirred water bath at 13 degrees C and inducing ischemia by placing an inflatable tourniquet around a finger for five minutes 2.
- After the tourniquet is deflated, the temperature of the finger is compared with that of an adjacent finger serving as control, and hyperemia is calculated as the increase in differential temperature between these two fingers after tourniquet release minus the difference in temperature existing before deflating the tourniquet 2.
- A normal lower limit of 0.7 degrees C for hyperemia is used to diagnose Raynaud's phenomenon, with a sensitivity of 93% and specificity of 93% 2.
Diagnosis and Classification
- Raynaud's phenomenon is a clinical diagnosis, and the term 'primary RP' is generally applied when no underlying pathology can be demonstrated 3.
- The term 'secondary RP' encompasses a broad range of rheumatological, haematological, endocrinological and vascular pathology 3.
- Diagnosis of primary Raynaud is mostly based on clinical presentation, while secondary Raynaud requires additional investigating techniques, including imaging investigations and laboratory tests to detect underlying disease 4.
Management and Treatment
- Treatment of Raynaud's disease is based on lifestyle modification, including smoking cessation, avoiding low outside temperatures, and limiting repeated hand actions 4.
- Drug treatment consists of calcium-channel blockers, nitroglycerine ointments, prostacyclins, and various new drugs such as endothelin receptor antagonists, phosphodiesterase inhibitors, and serotonin receptor antagonists 5, 4.