Referral for Raynaud's Phenomenon
Patients with Raynaud's phenomenon should be referred to a rheumatologist, particularly when secondary causes are suspected or when red flag features are present, such as digital ulceration, severe painful episodes, or systemic symptoms. 1
When to Refer to Rheumatology
Immediate Referral Required
- Digital ulcers or signs of critical ischemia 1
- Gangrene or tissue necrosis 2, 1
- Suspected early diffuse cutaneous systemic sclerosis or interstitial lung disease 1
- Severe, painful episodes with potential for digital complications 2, 1
Prompt Referral Indicated
- Suspected secondary Raynaud's phenomenon associated with connective tissue diseases (systemic sclerosis, systemic lupus erythematosus, rheumatoid arthritis) 1, 3
- Red flag features including systemic or constitutional symptoms 1
- Older age at onset (particularly over 60 years, where atherosclerotic disease may be present) 4
- Features suggesting underlying connective tissue disease on examination (joint deformities, scleroderma changes, facial rosacea) 2
- Entire hand involvement rather than individual digits (suggests secondary Raynaud's) 2
Primary Care Management Appropriate
- Primary Raynaud's (isolated vasospastic attacks without underlying disease) can often be managed in primary care with non-pharmacological measures and calcium channel blockers 2, 3
- Mild symptoms affecting individual digits only, without ulceration or systemic features 2
Why Rheumatologists Are the Appropriate Specialists
Rheumatologists are specifically trained to evaluate and manage connective tissue diseases that commonly underlie secondary Raynaud's phenomenon. 1 Systemic sclerosis is the most common association with secondary Raynaud's, and early rheumatologic evaluation is critical to prevent progression to digital ulcers and other serious complications 5, 2. Rheumatologists can perform appropriate laboratory testing (ANA, rheumatoid factor, anti-CCP, ESR/CRP) and guide escalation of therapy when first-line treatments fail 1.
Common Pitfalls to Avoid
- Missing secondary causes such as systemic sclerosis can lead to delayed treatment and poor outcomes, including digital ulcers and potential amputation 2, 3
- Delaying referral in patients with red flag features increases risk of irreversible digital ischemia 1
- Assuming all Raynaud's is benign when severe painful episodes or digital changes should prompt immediate specialist evaluation 6
- Continuing medications that worsen Raynaud's (beta-blockers, ergot alkaloids, bleomycin, clonidine) without specialist input 2, 3
Additional Specialist Referrals
While rheumatology is the primary referral for Raynaud's evaluation, consider: