Signs of Raynaud's Disease
Classic Clinical Presentation
Raynaud's phenomenon is characterized by episodic, well-defined color changes of the digits (typically fingers and toes) triggered by cold exposure or emotional stress, presenting as a triphasic sequence: white (pallor from vasoconstriction), blue (cyanosis), and red (reactive hyperemia). 1, 2
Primary Clinical Features
- Triphasic color changes are the hallmark sign, though not all three phases need to be present for diagnosis 2
- Episodes are triggered by cold exposure or emotional stress and resolve with rewarming 1, 3
- Symptoms typically affect individual digits rather than the entire hand in primary Raynaud's 4
- The vasospastic attacks cause temporary digital ischemia that is reversible 5, 6
Distinguishing Primary vs. Secondary Raynaud's
Signs Suggesting Primary (Idiopathic) Raynaud's:
- Mild, self-limited episodes without tissue damage 6
- Affects individual digits symmetrically 4
- No digital ulcers, gangrene, or tissue loss 1
- Younger age at onset 7
Red Flag Signs Indicating Secondary Raynaud's:
- Severe, painful episodes that are more persistent 1, 4
- Digital ulceration, tissue necrosis, or gangrene (occurs in 22.5% and 11% respectively in systemic sclerosis-associated cases) 4
- Involvement of entire hand rather than just individual digits 4
- Associated systemic symptoms including joint pain, skin changes, dysphagia, weight loss, malaise, fatigue, fever, photosensitivity, pleuritis, dry eyes, or dry mouth 4
- Older age at onset 7
Important Clinical Pitfalls
- Fever is rare in primary Raynaud's—its presence suggests underlying connective tissue disease or alternative diagnosis 4
- Always evaluate for systemic sclerosis and other connective tissue diseases, as Raynaud's is the initial manifestation in 70% of systemic sclerosis patients and may precede other disease features by years 1, 6
- Secondary Raynaud's represents not just vasospasm but also fixed vascular obstruction, leading to more severe and persistent manifestations 3