Materiały źródłowe

• #1 Raynaud’s Syndrome | Diagnosis & Disease Information

  https://www.rheumatologyadvisor.com/ddi/raynauds-syndrome/

  Raynauds syndrome is primarily a clinical diagnosis. The patient often self-reports symptoms because they typically occur episodically, rather than during an office visit. Elements of the patients history should include the age of onset, location of affected areas, presence of symmetry, presence of digital ulcerations, and severity of the attacks. Because primary Raynaud syndrome occurs as a response to stimuli, such as cold or emotional stress, the patients history should also include an assessment of aggravating factors. Seasonal variation may also be reported due to change in cold stimuli across seasons. The most common skin finding associated with Raynauds phenomenon is skin pallor, also called white attack, of the distal fingers lasting approximately 20 minutes, which may lead to cyanosis, followed by reactive hyperemia, or vascular reperfusion and warming, which presents as erythematous areas. Diagnosis typically requires a description of at least two (biphasic) color changes of the digits. Usually these attacks begin with one finger and spread to the others but spare the thumb. If the thumb is involved, secondary Raynaud syndrome is more likely. Report of a pins-and-needles sensation, pain, or numbness may also be associated with these attacks. These sensations occur due to tissue ischemia. Pain or more persistent sensations may be associated with secondary Raynauds syndrome etiologies, such as SSc. Additionally, patients may report that these changes and sensations occur in other parts on the body, including toes, ears, nose, knees, and areolar tissue. Since Raynauds syndrome may also occur secondary to another disease state, a review of systemic symptoms is also necessary. Questions that may elicit secondary Raynauds syndrome etiology include asking about symptoms that point to underlying connective tissue disorder, like photosensitivity or mouth ulcers, and symptoms that indicate severe disease, like digital ulcers. People with more severe Raynauds syndrome may also report impact on quality of life due to decreased hand function related to digital ulceration. A positive response to all 3 questions of the Raynauds syndrome screening typically confirms the diagnosis: Are your fingers sensitive to cold? Do your fingers change color when they are exposed to cold temperatures? Do your fingers turn white, blue, or both? Referral to rheumatology for further evaluation is recommended to differentiate between primary and secondary Raynaud syndrome. Age may suggest primary or secondary etiology, as those with primary Raynaud syndrome typically develop symptoms between age 15 and 25. Features that should prompt consideration of secondary Raynaud syndrome include being male, first developing symptoms after age 30, signs of tissue ischemia, abnormal laboratory parameters that suggest another disease, and having unilateral symptoms.

• #1 Diagnosing Raynaud’s Phenomenon | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/blood-heart-circulation/raynauds-phenomenon/diagnosis.html

  To diagnose Raynaud’s, your doctor will ask you questions about your symptoms and do a physical exam. You’ll need to describe what happens during an attack. If you can take a photo of the affected area during an attack, the photo may also be helpful to your doctor. […] There are no tests that can show that you have Raynaud’s. But your doctor may do a blood test or other tests to rule out diseases that may be causing your symptoms.

• #1 Raynaud’s disease – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/raynauds-disease/diagnosis-treatment/drc-20363572

  Your healthcare professional asks about your symptoms and medical history and does a physical exam. You also might have tests to rule out other medical problems that can cause the same symptoms. […] A test called nailfold capillaroscopy can tell the difference between primary and secondary Raynaud’s. During the test, the professional uses a microscope or magnifier to look for anything unusual on the skin at the base of a fingernail. This might include swelling of the blood vessels. […] Blood tests can help find out whether another condition, such as an autoimmune condition or a connective tissue disease, is causing Raynaud’s. Blood tests for Raynaud’s might include: […] No one blood test can diagnose Raynaud’s. Other tests, such as those that rule out diseases of the blood vessels, can help find a condition that can be related to Raynaud’s. […] Your primary health care provider will likely be able to diagnose Raynaud’s based on your symptoms. You may be referred to a provider trained in disorders of the joints, bones and muscles. This type of health care provider is called a rheumatologist. […] Don’t hesitate to ask other questions.

• #1 Raynaud’s Syndrome: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/9849-raynauds-phenomenon

  Healthcare providers can typically diagnose Raynauds syndrome from your symptoms. Your provider may ask you to take photos of your skin changes when they happen. Your provider may also perform a physical exam and talk with you about your medical and family history. […] Raynauds syndrome is usually easy to diagnose. But it may not be obvious whether you have the primary or secondary form. Thats where diagnostic testing can help. […] Several diagnostic tests can help determine if you have primary or secondary Raynauds syndrome. […] One test thats particularly useful is a nailfold capillaroscopy. For this test, your provider places a drop of oil on your skin at the base of your fingernail. This spot is called your nailfold. Your provider then looks at your nailfold under a microscope. If your capillaries in the area are enlarged or abnormal, you may have a connective tissue disease. This would indicate you likely have secondary Raynauds syndrome.

• #1 Raynaud’s Phenomenon: A Current Update on Pathogenesis, Diagnostic Workup, and Treatment

  https://www.vsijournal.org/journal/view.html?uid=1349&vmd=Full

  Several diagnostic criteria for RP exist, with some minor variations. All criteria share the core principle of requiring cold-induced digital skin color changes. […] Normal nailfold capillaroscopy is a crucial imaging tool that provides detailed information about the structural condition of capillaries in the nail folds. […] Although a normal NFC finding typically suggests primary RP, distinguishing between normal and abnormal images, and further classifying abnormal patterns as scleroderma or non-scleroderma, can be challenging. […] Perfusion scintigraphy is a functional imaging technique that directly assesses blood flow in the digits using a tracer radioactive substance, such as Technetium-99m pertechnetate. […] Dynamic Doppler sonography is a non-invasive imaging modality that aids in differentiating primary from secondary RP.

• #1 Raynaud Phenomenon Workup: Approach Considerations, Laboratory Studies, Magnetic Resonance Imaging

  https://emedicine.medscape.com/article/331197-workup

  Raynaud phenomenon can be diagnosed on clinical grounds. Laboratory testing is necessary to assess for conditions that can mimic Raynaud phenomenon or cause secondary Raynaud phenomenon. The selection of tests should be guided by the clinical findings. […] Nailfold capillaroscopy is the gold standard for differentiating primary Raynaud phenomenon from secondary Raynaud phenomenon (in particular, for identifying a scleroderma pattern). European guidelines note that capillaroscopy is not often performed in primary care, but recommend its use in secondary care, as abnormal capillary patterns are strong predictors of connective tissue disease. […] The following laboratory studies may be considered in patients with Raynaud phenomenon: Complete blood cell count – To evaluate for polycythemic disorders, underlying malignancies, or autoimmune disorders; Blood urea nitrogen – To evaluate for possible renal impairment or dehydration; Creatinine – To evaluate for kidney dysfunction; Prothrombin time – To evaluate for liver dysfunction; Activated partial thromboplastin time – To evaluate for antiphospholipid antibody disorder or liver dysfunction; Serum glucose – To evaluate for diabetes; Thyroid-stimulating hormone – To test for thyroid disorders.

• #1 Cold Stimulation Test: MedlinePlus Medical TestLock

  https://medlineplus.gov/lab-tests/cold-stimulation-test/

  A cold stimulation test involves placing your fingers in ice water and checking to see how long it takes your skin to return to a normal temperature. This test is used to find out if you have Raynaud phenomenon. […] Your provider will usually diagnose Raynaud phenomenon by doing a physical exam and reviewing your symptoms and medical history. Some providers also use a cold stimulation test to help confirm your diagnosis of Raynaud phenomenon. […] If it takes 20 minutes or more for your finger temperature to return to normal after the ice water bath, it probably means you have Raynaud phenomenon. If your symptoms are severe and/or you are age 35 or older, you may have secondary Raynaud phenomenon. […] If your health care provider thinks you have secondary Raynaud phenomenon, they may order more tests to help diagnose the disorder that is causing it. These tests can include: Nailfold capillaroscopy. For this test, your provider will place a drop of oil on the base of one of your fingernails. The nail area is then examined under a microscope. If abnormal arteries are seen, it can be a sign of scleroderma or other connective tissue disease. […] Blood tests to check for immune system disorders. These include an antinuclear antibody (ANA) test, erythrocyte sedimentation rate (ESR), and C-reactive protein.

• #1

  https://viasonix.com/vascular-angiology/raynauds-syndrome/

  To diagnose Raynauds Disease, physiological tests are typically performed. Such tests include measuring of photoplethysmography (PPG) waveforms with or without blood pressure in the fingers or toes, both at room temperature and after cold immersion. […] This step-by-step guide for performing a Raynauds test is for informational purposes only. Healthcare professionals should rely on their expertise, clinical judgment, and institutional protocols for accurate administration and interpretation. Additional clinical information, patient history, physical examination, and other diagnostic tests may be necessary for comprehensive evaluation. […] During a Raynauds Syndrome test, several expected results and observations can be noted. First, during the cold immersion phase, the affected area may exhibit color changes, turning white or blue due to vasoconstriction and reduced blood flow. This discoloration serves as a characteristic sign of Raynauds Syndrome.

• #1

  https://viasonix.com/vascular-angiology/raynauds-syndrome/

  Additionally, the focus of the test is on the time it takes for the PPG waveforms to return to their pre-immersion amplitude levels after exposure to cold temperatures. […] It is expected that the PPG waveforms will gradually recover and return to their baseline levels within approximately 10 minutes or so. This recovery time can vary depending on individual factors and the severity of the condition. A longer duration for the waveforms to return to pre-immersion levels may indicate the presence of a disease condition related to Raynauds Phenomenon. […] Systolic blood pressure measurements can provide further insights into the diagnosis. In cases of secondary Raynauds, a decrease in systolic blood pressure compared to primary Raynauds is typically observed. This difference in blood pressure readings can help distinguish between primary and secondary forms of the condition.

• #1 Raynaud’s Disease: Types, Symptoms, Diagnosis, & Treatment

  https://www.artemishospitals.com/blog/raynaud-s-disease-types-symptoms-diagnosis-treatment

  Raynauds Disease Diagnosis […] A doctor diagnoses Raynauds disease based on an individuals symptoms. A few diagnostic tests that a doctor may recommend to determine primary or secondary Raynauds syndrome and its causes are: […] CBC (Complete Blood Count): Blood test that checks for a range of conditions. […] ESR (Erythrocyte Sedimentation Test): Blood test that checks for inflammation in the body. […] Urinalysis: Urine test that detects a range of conditions linked to Raynauds disease. […] Pulse volume recording: A type of non-invasive test that checks the blood flow in the arms and legs. […] RF (Rheumatoid Factor) test: Blood test that checks for autoimmune diseases.

• #1 Raynaud’s Syndrome | Diagnosis & Disease Information

  https://www.rheumatologyadvisor.com/ddi/raynauds-syndrome/

  A rheumatologist typically performs the detailed diagnostic workup to differentiate primary and secondary Raynaud syndrome. This is due to the possible connective tissue disease etiologies of Raynaud syndrome. A nailfold capillary microscopy analysis of microvascular and morphologic changes in peripheral vessels is a non-invasive way to differentiate between primary and secondary Raynaud syndrome. This analysis uses a dermatoscope, ophthalmoscope, or USB microscope to visualize nailfold capillaries, which run parallel, rather than perpendicular, to the nail surface. While the gold standard technique uses high magnification videocapillaroscopy, low-magnification techniques, such as the use of a dermatoscope, ophthalmoscope, or USB microscope can quickly and easily detect abnormalities. Nailfold capillary microscopy is primarily useful for excluding SSc, which features the presence of giant capillaries, microhemorrhages, or avascular areas. Additional analysis may include a functional assessment of digital perfusion using infrared thermography or laser-derived methods, though these techniques are primarily reserved for research settings. Like nailfold capillary microscopy, infrared thermography can differentiate between primary Raynauds syndrome and SSc by indirectly measuring digital blood flow. Other analysis methods that have been used, such as finger systolic pressure measurements, require further validation. The workup may also include laboratory investigations, which should be tailored to the clinical findings. Examples of relevant studies include a complete blood count, comprehensive metabolic panel, rheumatoid factor, anti-cyclic citrullinated peptide, thyroid studies, hepatitis screening, anti-neutrophil cytoplasmic antibodies, and antiphospholipid antibodies. Additionally, because secondary Raynauds syndrome is associated with connective tissue disorders, testing for autoantibodies associated with these disorders may be performed through laboratory testing for antinuclear antibody by immunofluorescence (ANA), anti-double stranded DNA, anti-SSA, anti-SSB, anti-Smith, anti-ribonucleoprotein, anti-Scl-70, anti-centromere, anti-fibrillarin, anti-Pm-Scl, and anti-RNA polymerase III. Finally, clinical features consistent with etiologies such as SLE or cryoglobulinemia warrant laboratory testing for creatinine kinase, immunoglobulins with protein electrophoresis, and fasting lipid profile. The minimal set of investigations should include nailfold capillary microscopy, complete blood count, erythrocyte sedimentation rate (ESR), and ANA.

• #1 Raynaud Phenomenon Workup: Approach Considerations, Laboratory Studies, Magnetic Resonance Imaging

  https://emedicine.medscape.com/article/331197-workup

  Smitaman and colleagues report that magnetic resonance imaging (MRI) scans of the feet of patients with Raynaud phenomenon demonstrate a progressive distal-to-proximal pattern of phalangeal bone marrow edema. They suggest that this finding may allow early diagnosis and treatment of rheumatologic disorders that may be associated with Raynaud phenomenon. […] Using cardiac MRI, Quarta et al demonstrated the presence of cold-induced cardiac ischemia in patients with systemic sclerosis and secondary Raynaud phenomenon, and showed that therapy with iloprost can reduce episodes of cardiac Raynaud phenomenon.

• #1 Raynaud Phenomenon Differential Diagnoses

  https://emedicine.medscape.com/article/331197-differential

  Distinguishing primary Raynaud phenomenon from secondary Raynaud phenomenon is vital; primary Raynaud phenomenon is benign, while secondary Raynaud phenomenon can result in permanent and potentially devastating tissue destruction if it is not diagnosed and treated. […] Anatomic syndromes that may be confused with Raynaud phenomenon include the following: Carpal tunnel syndrome, Complex regional pain syndrome (reflex sympathetic dystrophy), Thoracic outlet syndrome. […] Miscellaneous circulatory syndromes that may be confused with Raynaud phenomenon include the following: Peripheral vascular disease, Thromboangiitis obliterans, Vasculitis, Thromboembolic disease. […] Vasospastic syndromes that may be confused with Raynaud phenomenon include the following: Livedo reticularis, Acrocyanosis, Chilblains.

• #1 Clinical manifestations and diagnosis of Raynaud phenomenon – UpToDate

  https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-raynaud-phenomenon

  Clinical manifestations and diagnosis of Raynaud phenomenon […] The clinical manifestations and diagnosis of RP are reviewed here. […] Primary versus secondary Raynaud phenomenon — Patients with Raynaud phenomenon (RP) are described as having either a primary or secondary process. […] Primary RP – Primary RP or idiopathic Raynaud disease are terms to describe manifestations in patients without evidence of any associated disorder as a cause for their vascular events. […] Diagnosis of Raynaud phenomenon […] Evaluation of the patient with presumptive Raynaud phenomenon […] Laboratory testing for secondary Raynaud phenomenon […] Vascular imaging for atypical attacks

• #1 Raynaud’s Syndrome | Diagnosis & Disease Information

  https://www.rheumatologyadvisor.com/ddi/raynauds-syndrome/

  The differential diagnosis includes primary and secondary Raynauds syndrome. In one study, 13% of patients thought to have primary Raynaud syndrome were later diagnosed with secondary Raynaud syndrome. Progression to secondary Raynaud syndrome has typically been noted within 5 years of initial diagnosis with primary Raynaud syndrome. For patients who present with symptoms that are more consistent with primary Raynaud syndrome but who also have weakly positive ANA testing or borderline widened capillaries on a nailfold capillary microscopy, repeating the nailfold capillary microscopy within 6 to 12 months may help establish a more accurate diagnosis. Patients at higher risk of developing secondary Raynaud syndrome may need annual reevaluation for up to 5 years. The differential diagnosis for secondary Raynaud syndrome is very broad and includes a large number of conditions. As there is a high prevalence of secondary Raynaud syndrome within the population of patients with autoimmune rheumatic diseases, these conditions must be considered closely within the differential diagnosis of primary Raynaud syndrome. In particular, connective tissue diseases, such as SSc and mixed connective tissue disease (MCTD), should be included in the differential diagnosis, in addition to SLE, Sjogren syndrome (SS), and others. Because secondary Raynaud syndrome is common in patients with autoimmune connective tissue disorders, it is especially important to closely consider these diseases as part of the differential diagnosis. These connective tissue disorders can be severe and difficult to treat. As discussed previously, secondary Raynaud syndrome is a common presenting feature of SSc, and almost all patients with SSc have Raynaud syndrome. Presence of Raynaud syndrome alongside positive ANA should alert the clinician to this diagnosis. In SSc patients, Raynaud syndrome is especially likely to become severe and progress to ulceration and gangrene. Another important disease to consider is MCTD. As with SSc, most patients with MCTD have Raynaud syndrome. In fact, Raynaud syndrome may be one of the few presenting symptoms upon diagnosis of MCTD. In patients with MCTD, ulceration of fingers is rare when compared to the rate of this complication in patients with SSc. Raynaud syndrome also occurs in half of patients with undifferentiated connective tissue disease. SS is also commonly associated with Raynauds syndrome, and these symptoms may occur prior to the appearance of other symptoms more typically associated with SS. The prevalence of Raynaud syndrome in patients with SLE is estimated to be 18% to 40%, and its presence is a potential biomarker for internal organ complications. Additionally, patients with SLE who also have Raynaud syndrome are more likely to develop arterial and venous thromboses. Secondary Raynaud syndrome can also occur within the context of idiopathic inflammatory myopathies and may present as cutaneous ulcers. Additionally, conditions that lead to impaired vascular perfusion must be considered. These conditions include large vessel disease that occurs due to compressive, neurogenic, inflammatory, or atherosclerotic causes, as well as vaso-occlusive disease that may occur due to cryoglobulinemia, cryofibrinogenemia, and others. As mentioned previously, secondary Raynaud syndrome may also occur due to drugs or chemical exposure. Another occupational differential diagnosis is handarmvibration syndrome, which may occur within the context of work with the use of vibratory tools. Finally, the differential diagnosis also includes frostbite, hypothyroidism, and fibromyalgia syndrome, among others.

• #1 Raynaud Phenomenon Differential Diagnoses

  https://emedicine.medscape.com/article/331197-differential

  Other problems to be considered in the differential diagnosis of Raynaud phenomenon include the following: Cryoglobulinemia, mixed or type 3, associated with hepatitis B and C, Cryoglobulinemia, monoclonal or type I, Dermatomyositis, Fabry disease, Leukemia, Lymphoma, Mycoplasma infection with cold agglutinins, Myeloma, Scleroderma, diffuse and localized (CREST syndrome), Systemic lupus erythematosus (SLE), Vibration injury, Vinyl chloride exposure, Waldenstrm macroglobulinemia. […] Drugs to be considered in the differential diagnosis of Raynaud phenomenon include the following: Alfa-interferon, Antineoplastics (eg, vinca alkaloids, bleomycin, cisplatin), Beta-adrenergic blocking drugs, Bromocriptine, Cocaine, Cyclosporine, Ergot alkaloids, Oral contraceptives.

• #1 Raynaud Disease | Riley Children’s Health

  https://www.rileychildrens.org/health-info/raynaud-disease

  Raynaud disease is the tendency of cold temperatures and anxiety to trigger spasms in the arteries of the arms and legs, which causes skin discoloration and discomfort. […] If you believe your child may have Raynaud disease, you should seek the evaluation of a pediatric rheumatologist who can make a correct diagnosis: Many teens have hyper-reactivity of their blood vessels that is less severe and does not lead to tissue injury. This is called acrocyanosis, and it is not harmful. […] In diagnosing Raynaud disease, your child’s doctor will determine if there is an underlying immune disease causing the condition, which is known as secondary Raynaud phenomenon. If your child has no underlying medical condition causing this condition, then he or she is said to have primary Raynaud disease. Because there is no single blood test that can help your child’s doctor pinpoint Raynaud specifically, one or more of the following tests may be performed to determine if your child has a related or underlying condition:

• #1 Raynaud’s Disease (Causes, Symptoms and Treatment)

  https://patient.info/doctor/raynauds-phenomenon-pro

  In classically presenting primary Raynaud’s disease, in a young woman who is well and has no evidence of other causes on examination, you are unlikely to detect anything on investigation: […] If there is reason to suspect an underlying cause then investigations should be directed to confirming or refuting the association as below: […] Refer patients with suspected secondary Raynaud’s disease for capillaroscopy if available. Other investigations performed in secondary care include infrared thermography, laser Doppler flowmetry, portable radiometry, and digital plethysmography. […] Primary Raynaud’s is typically benign and does not progress or lead to tissue damage. […] An underlying disorder develops in 13% of cases of the primary form. […] Most patients have a stable course and over half improve over time. […] Secondary cases are more prone to be problematic – ulceration, scarring, or gangrene occur in 17% of people with Raynaud’s disease secondary to systemic sclerosis.

• #1 Raynaud’s Disease Clinic – Brigham and Women’s Hospital

  https://www.brighamandwomens.org/medicine/rheumatology-inflammation-immunity/services/raynauds-disease-clinic

  Patients at our Raynauds Disease Clinic are initially evaluated by two physicians a vascular medicine specialist and a rheumatologist. Much of the diagnosis will focus on evaluating symptoms. Along with a complete medical history and a medical exam, our team will typically order at least one type of blood test. A patient also may undergo a cold challenge test to bring out color changes in the hands or feet. […] With Secondary Raynauds phenomenon, its also important to identify and treat the underlying autoimmune or other disorder that may be causing Raynauds phenomenon.

• #1 Raynaud’s Phenomenon: A Common Sense Approach to Diagnosis and Management

  https://practicingclinicians.com/the-exchange/raynaud-s-phenomenon-a-common-sense-approach-to-diagnosis-and-management

  Raynaud’s phenomenon (RP) is all too common in New England during the colder months of the year. […] In the workup of a patient with Raynaud’s who has clinical evidence of systemic autoimmune disease, laboratory studies should include antinuclear antibodies (ANA), looking for a nucleolar pattern, anti-centromere, and anti-topoisomerase (ScL-70, IgG, and IgA – rarely IgM) antibodies. […] It is also useful to utilize nailfold capillary microscopy; this is performed with an ophthalmoscope using a diopter setting of 40 and an immersion oil droplet placed on the cuticle. […] For patients unresponsive to the above measures and who are experiencing an acute ischemic crisis with threat of a digital infarct, several steps should be considered: Admit to the hospital, Put the patient in a warm and quiet environment, Control pain with a chemical sympathectomy (eg, with prostaglandin 1 or prostaglandin E), which can allow needed medications to get to the affected digits, Try to avoid narcotics; they increase vasospasm but can be used if needed, Anti-platelet therapy with aspirin 81 mg, Heparin, especially if the patient has APLS. […] Surgical options are available for those who are refractory to chemical intervention.

• #2 Raynaud’s disease – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/raynauds-disease/diagnosis-treatment/drc-20363572

  Your healthcare professional asks about your symptoms and medical history and does a physical exam. You also might have tests to rule out other medical problems that can cause the same symptoms. […] A test called nailfold capillaroscopy can tell the difference between primary and secondary Raynaud’s. During the test, the professional uses a microscope or magnifier to look for anything unusual on the skin at the base of a fingernail. This might include swelling of the blood vessels. […] Blood tests can help find out whether another condition, such as an autoimmune condition or a connective tissue disease, is causing Raynaud’s. Blood tests for Raynaud’s might include: […] No one blood test can diagnose Raynaud’s. Other tests, such as those that rule out diseases of the blood vessels, can help find a condition that can be related to Raynaud’s. […] Your primary health care provider will likely be able to diagnose Raynaud’s based on your symptoms. You may be referred to a provider trained in disorders of the joints, bones and muscles. This type of health care provider is called a rheumatologist. […] Don’t hesitate to ask other questions.

• #2 Raynaud’s Syndrome: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/9849-raynauds-phenomenon

  Healthcare providers can typically diagnose Raynauds syndrome from your symptoms. Your provider may ask you to take photos of your skin changes when they happen. Your provider may also perform a physical exam and talk with you about your medical and family history. […] Raynauds syndrome is usually easy to diagnose. But it may not be obvious whether you have the primary or secondary form. Thats where diagnostic testing can help. […] Several diagnostic tests can help determine if you have primary or secondary Raynauds syndrome. […] One test thats particularly useful is a nailfold capillaroscopy. For this test, your provider places a drop of oil on your skin at the base of your fingernail. This spot is called your nailfold. Your provider then looks at your nailfold under a microscope. If your capillaries in the area are enlarged or abnormal, you may have a connective tissue disease. This would indicate you likely have secondary Raynauds syndrome.

• #2 Raynaud Phenomenon Workup: Approach Considerations, Laboratory Studies, Magnetic Resonance Imaging

  https://emedicine.medscape.com/article/331197-workup

  Raynaud phenomenon can be diagnosed on clinical grounds. Laboratory testing is necessary to assess for conditions that can mimic Raynaud phenomenon or cause secondary Raynaud phenomenon. The selection of tests should be guided by the clinical findings. […] Nailfold capillaroscopy is the gold standard for differentiating primary Raynaud phenomenon from secondary Raynaud phenomenon (in particular, for identifying a scleroderma pattern). European guidelines note that capillaroscopy is not often performed in primary care, but recommend its use in secondary care, as abnormal capillary patterns are strong predictors of connective tissue disease. […] The following laboratory studies may be considered in patients with Raynaud phenomenon: Complete blood cell count – To evaluate for polycythemic disorders, underlying malignancies, or autoimmune disorders; Blood urea nitrogen – To evaluate for possible renal impairment or dehydration; Creatinine – To evaluate for kidney dysfunction; Prothrombin time – To evaluate for liver dysfunction; Activated partial thromboplastin time – To evaluate for antiphospholipid antibody disorder or liver dysfunction; Serum glucose – To evaluate for diabetes; Thyroid-stimulating hormone – To test for thyroid disorders.

• #2 Raynaud’s Syndrome | Diagnosis & Disease Information

  https://www.rheumatologyadvisor.com/ddi/raynauds-syndrome/

  A rheumatologist typically performs the detailed diagnostic workup to differentiate primary and secondary Raynaud syndrome. This is due to the possible connective tissue disease etiologies of Raynaud syndrome. A nailfold capillary microscopy analysis of microvascular and morphologic changes in peripheral vessels is a non-invasive way to differentiate between primary and secondary Raynaud syndrome. This analysis uses a dermatoscope, ophthalmoscope, or USB microscope to visualize nailfold capillaries, which run parallel, rather than perpendicular, to the nail surface. While the gold standard technique uses high magnification videocapillaroscopy, low-magnification techniques, such as the use of a dermatoscope, ophthalmoscope, or USB microscope can quickly and easily detect abnormalities. Nailfold capillary microscopy is primarily useful for excluding SSc, which features the presence of giant capillaries, microhemorrhages, or avascular areas. Additional analysis may include a functional assessment of digital perfusion using infrared thermography or laser-derived methods, though these techniques are primarily reserved for research settings. Like nailfold capillary microscopy, infrared thermography can differentiate between primary Raynauds syndrome and SSc by indirectly measuring digital blood flow. Other analysis methods that have been used, such as finger systolic pressure measurements, require further validation. The workup may also include laboratory investigations, which should be tailored to the clinical findings. Examples of relevant studies include a complete blood count, comprehensive metabolic panel, rheumatoid factor, anti-cyclic citrullinated peptide, thyroid studies, hepatitis screening, anti-neutrophil cytoplasmic antibodies, and antiphospholipid antibodies. Additionally, because secondary Raynauds syndrome is associated with connective tissue disorders, testing for autoantibodies associated with these disorders may be performed through laboratory testing for antinuclear antibody by immunofluorescence (ANA), anti-double stranded DNA, anti-SSA, anti-SSB, anti-Smith, anti-ribonucleoprotein, anti-Scl-70, anti-centromere, anti-fibrillarin, anti-Pm-Scl, and anti-RNA polymerase III. Finally, clinical features consistent with etiologies such as SLE or cryoglobulinemia warrant laboratory testing for creatinine kinase, immunoglobulins with protein electrophoresis, and fasting lipid profile. The minimal set of investigations should include nailfold capillary microscopy, complete blood count, erythrocyte sedimentation rate (ESR), and ANA.

• #2 Raynaud’s phenomenon | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/a-to-z/raynauds-phenomenon/

  Raynauds phenomenon can usually be diagnosed after an examination of your symptoms and some blood tests. […] Your GP may place your hands in cold water or cool air to see if you show symptoms of Raynauds. […] Further testing is usually recommended to find out whether you have primary or secondary Raynauds. […] Secondary Raynauds may require more treatment and, in some cases, referral to a specialist. […] Your GP may also check the tiny blood vessels, known as capillaries, found where your nail meets the finger. These capillaries are often larger in people with secondary Raynauds, and look like red pen marks. […] Your GP may also refer you for blood tests to check for other health conditions that could be causing your symptoms. These tests may include: a full blood count to check for infection or, much less commonly, a cancer of the blood, such as leukaemia; an antinuclear antibodies (ANA) test to check for an overactive immune system, which is common in people with autoimmune conditions such as scleroderma and lupus; erythrocyte sedimentation rate to check for an autoimmune disorder.

• #2

  https://viasonix.com/vascular-angiology/raynauds-syndrome/

  Additionally, the focus of the test is on the time it takes for the PPG waveforms to return to their pre-immersion amplitude levels after exposure to cold temperatures. […] It is expected that the PPG waveforms will gradually recover and return to their baseline levels within approximately 10 minutes or so. This recovery time can vary depending on individual factors and the severity of the condition. A longer duration for the waveforms to return to pre-immersion levels may indicate the presence of a disease condition related to Raynauds Phenomenon. […] Systolic blood pressure measurements can provide further insights into the diagnosis. In cases of secondary Raynauds, a decrease in systolic blood pressure compared to primary Raynauds is typically observed. This difference in blood pressure readings can help distinguish between primary and secondary forms of the condition.

• #2 Raynaud’s – getting diagnosed | SRUK

  https://www.sruk.co.uk/raynauds/raynauds-getting-diagnosed/

  Raynaud’s phenomenon is often diagnosed by a GP based upon your symptoms and your medical history. […] It is likely that they will also arrange some blood tests, so that any underlying health conditions can be ruled out. […] Blood tests can be used to check for other health conditions that could be causing your symptoms. […] These tests may include: a full blood count to check for infection or, much less commonly, a cancer of the blood, such as leukaemia; an antinuclear antibodies (ANA) test to check for an overactive immune system, which is common in people with autoimmune conditions such as rheumatoid arthritis and lupus; erythrocyte sedimentation rate this test determines the rate at which red blood cells settle to the bottom of a tube. A faster than normal rate may signal an underlying inflammatory or autoimmune disease such as arthritis or lupus.

• #2 Raynaud’s Syndrome: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/9849-raynauds-phenomenon

  Other tests your provider may order include: Antinuclear antibody (ANA) test: Blood test that checks for autoimmune diseases. Complete blood count (CBC): Blood test that checks for a range of conditions. Erythrocyte sedimentation rate (ESR) test: Blood test that detects inflammation in your body. Helps diagnose rheumatoid and autoimmune disorders, among other conditions. Urinalysis: Urine test that checks for a range of conditions. Pulse volume recording: Noninvasive test that checks blood flow in your arms and legs. Rheumatoid factor (RF) test: Blood test that checks for autoimmune diseases. […] These tests can help your provider identify or rule out underlying conditions as causes of your Raynauds symptoms.

• #2 Raynaud’s Disease: Symptoms, Causes, Diagnosis, and Management – CK Birla Hospital

  https://www.ckbhospital.com/blogs/raynauds-disease-causes-symptoms-treatment/

  How is Raynauds Disease Diagnosed? […] To determine primary or secondary Raynauds syndrome, various diagnostic tests are available, such as: […] Nailfold Capillaroscopy: A drop of oil is placed at the base of your fingernail, and observed under a microscope to detect enlarged or abnormal capillaries, indicating possible connective tissue disease. […] Antinuclear Antibody (ANA) Test: Identifies autoimmune diseases through a blood test. […] Complete Blood Count (CBC): Detects a range of conditions through a blood test. […] Erythrocyte Sedimentation Rate (ESR) Test: Detects inflammation, aiding in the diagnosis of rheumatoid and autoimmune disorders. […] Urinalysis: Identifies various conditions through a urine test. […] Pulse volume Recording: Noninvasive test assessing blood flow in arms and legs. […] Rheumatoid Factor (RF) Test: Identifies autoimmune diseases through a blood test. […] These tests assist in diagnosing or ruling out underlying conditions contributing to Raynauds symptoms.

• #2 Raynaud’s Syndrome | Diagnosis & Disease Information

  https://www.rheumatologyadvisor.com/ddi/raynauds-syndrome/

  Raynauds syndrome is primarily a clinical diagnosis. The patient often self-reports symptoms because they typically occur episodically, rather than during an office visit. Elements of the patients history should include the age of onset, location of affected areas, presence of symmetry, presence of digital ulcerations, and severity of the attacks. Because primary Raynaud syndrome occurs as a response to stimuli, such as cold or emotional stress, the patients history should also include an assessment of aggravating factors. Seasonal variation may also be reported due to change in cold stimuli across seasons. The most common skin finding associated with Raynauds phenomenon is skin pallor, also called white attack, of the distal fingers lasting approximately 20 minutes, which may lead to cyanosis, followed by reactive hyperemia, or vascular reperfusion and warming, which presents as erythematous areas. Diagnosis typically requires a description of at least two (biphasic) color changes of the digits. Usually these attacks begin with one finger and spread to the others but spare the thumb. If the thumb is involved, secondary Raynaud syndrome is more likely. Report of a pins-and-needles sensation, pain, or numbness may also be associated with these attacks. These sensations occur due to tissue ischemia. Pain or more persistent sensations may be associated with secondary Raynauds syndrome etiologies, such as SSc. Additionally, patients may report that these changes and sensations occur in other parts on the body, including toes, ears, nose, knees, and areolar tissue. Since Raynauds syndrome may also occur secondary to another disease state, a review of systemic symptoms is also necessary. Questions that may elicit secondary Raynauds syndrome etiology include asking about symptoms that point to underlying connective tissue disorder, like photosensitivity or mouth ulcers, and symptoms that indicate severe disease, like digital ulcers. People with more severe Raynauds syndrome may also report impact on quality of life due to decreased hand function related to digital ulceration. A positive response to all 3 questions of the Raynauds syndrome screening typically confirms the diagnosis: Are your fingers sensitive to cold? Do your fingers change color when they are exposed to cold temperatures? Do your fingers turn white, blue, or both? Referral to rheumatology for further evaluation is recommended to differentiate between primary and secondary Raynaud syndrome. Age may suggest primary or secondary etiology, as those with primary Raynaud syndrome typically develop symptoms between age 15 and 25. Features that should prompt consideration of secondary Raynaud syndrome include being male, first developing symptoms after age 30, signs of tissue ischemia, abnormal laboratory parameters that suggest another disease, and having unilateral symptoms.

• #2 Raynaud’s Disease (Causes, Symptoms and Treatment)

  https://patient.info/doctor/raynauds-phenomenon-pro

  In classically presenting primary Raynaud’s disease, in a young woman who is well and has no evidence of other causes on examination, you are unlikely to detect anything on investigation: […] If there is reason to suspect an underlying cause then investigations should be directed to confirming or refuting the association as below: […] Refer patients with suspected secondary Raynaud’s disease for capillaroscopy if available. Other investigations performed in secondary care include infrared thermography, laser Doppler flowmetry, portable radiometry, and digital plethysmography. […] Primary Raynaud’s is typically benign and does not progress or lead to tissue damage. […] An underlying disorder develops in 13% of cases of the primary form. […] Most patients have a stable course and over half improve over time. […] Secondary cases are more prone to be problematic – ulceration, scarring, or gangrene occur in 17% of people with Raynaud’s disease secondary to systemic sclerosis.

• #2 Raynaud’s Syndrome | Diagnosis & Disease Information

  https://www.rheumatologyadvisor.com/ddi/raynauds-syndrome/

  The differential diagnosis includes primary and secondary Raynauds syndrome. In one study, 13% of patients thought to have primary Raynaud syndrome were later diagnosed with secondary Raynaud syndrome. Progression to secondary Raynaud syndrome has typically been noted within 5 years of initial diagnosis with primary Raynaud syndrome. For patients who present with symptoms that are more consistent with primary Raynaud syndrome but who also have weakly positive ANA testing or borderline widened capillaries on a nailfold capillary microscopy, repeating the nailfold capillary microscopy within 6 to 12 months may help establish a more accurate diagnosis. Patients at higher risk of developing secondary Raynaud syndrome may need annual reevaluation for up to 5 years. The differential diagnosis for secondary Raynaud syndrome is very broad and includes a large number of conditions. As there is a high prevalence of secondary Raynaud syndrome within the population of patients with autoimmune rheumatic diseases, these conditions must be considered closely within the differential diagnosis of primary Raynaud syndrome. In particular, connective tissue diseases, such as SSc and mixed connective tissue disease (MCTD), should be included in the differential diagnosis, in addition to SLE, Sjogren syndrome (SS), and others. Because secondary Raynaud syndrome is common in patients with autoimmune connective tissue disorders, it is especially important to closely consider these diseases as part of the differential diagnosis. These connective tissue disorders can be severe and difficult to treat. As discussed previously, secondary Raynaud syndrome is a common presenting feature of SSc, and almost all patients with SSc have Raynaud syndrome. Presence of Raynaud syndrome alongside positive ANA should alert the clinician to this diagnosis. In SSc patients, Raynaud syndrome is especially likely to become severe and progress to ulceration and gangrene. Another important disease to consider is MCTD. As with SSc, most patients with MCTD have Raynaud syndrome. In fact, Raynaud syndrome may be one of the few presenting symptoms upon diagnosis of MCTD. In patients with MCTD, ulceration of fingers is rare when compared to the rate of this complication in patients with SSc. Raynaud syndrome also occurs in half of patients with undifferentiated connective tissue disease. SS is also commonly associated with Raynauds syndrome, and these symptoms may occur prior to the appearance of other symptoms more typically associated with SS. The prevalence of Raynaud syndrome in patients with SLE is estimated to be 18% to 40%, and its presence is a potential biomarker for internal organ complications. Additionally, patients with SLE who also have Raynaud syndrome are more likely to develop arterial and venous thromboses. Secondary Raynaud syndrome can also occur within the context of idiopathic inflammatory myopathies and may present as cutaneous ulcers. Additionally, conditions that lead to impaired vascular perfusion must be considered. These conditions include large vessel disease that occurs due to compressive, neurogenic, inflammatory, or atherosclerotic causes, as well as vaso-occlusive disease that may occur due to cryoglobulinemia, cryofibrinogenemia, and others. As mentioned previously, secondary Raynaud syndrome may also occur due to drugs or chemical exposure. Another occupational differential diagnosis is handarmvibration syndrome, which may occur within the context of work with the use of vibratory tools. Finally, the differential diagnosis also includes frostbite, hypothyroidism, and fibromyalgia syndrome, among others.

• #2 Raynaud Phenomenon Differential Diagnoses

  https://emedicine.medscape.com/article/331197-differential

  Other problems to be considered in the differential diagnosis of Raynaud phenomenon include the following: Cryoglobulinemia, mixed or type 3, associated with hepatitis B and C, Cryoglobulinemia, monoclonal or type I, Dermatomyositis, Fabry disease, Leukemia, Lymphoma, Mycoplasma infection with cold agglutinins, Myeloma, Scleroderma, diffuse and localized (CREST syndrome), Systemic lupus erythematosus (SLE), Vibration injury, Vinyl chloride exposure, Waldenstrm macroglobulinemia. […] Drugs to be considered in the differential diagnosis of Raynaud phenomenon include the following: Alfa-interferon, Antineoplastics (eg, vinca alkaloids, bleomycin, cisplatin), Beta-adrenergic blocking drugs, Bromocriptine, Cocaine, Cyclosporine, Ergot alkaloids, Oral contraceptives.

• #2 Raynaud’s Phenomenon: Symptoms, Causes, Diagnosis & Treatment

  https://www.clevelandclinicabudhabi.ae/en/health-hub/health-resource/diseases-and-conditions/raynauds-phenomenon

  If your doctor thinks you may have Raynaud’s, you will have a complete physical exam and your doctor will review your medical history to rule out other medical problems. Many times the condition itself is easily diagnosed. But, it may be more difficult to figure out what is causing it. […] Doctors often study the tiny blood vessels (capillaries) in the nail to help make a diagnosis. […] The results of this test (nailfold capillaroscopy) are normal if the patient has primary Raynaud’s. But, if the patient has the secondary form the results of this test will be abnormal. […] You may need other tests, such as a complete blood count (CBC), urinalysis, and chemistry profile to confirm secondary Raynaud’s. […] Your doctor may also order tests to help determine which type of Raynaud’s you have. These tests can include an antinuclear antibody test (ANA), erythrocyte sedimentation rate (ESR) test and checking for the rheumatoid factor and complement levels.

• #3 Raynaud’s Phenomenon or Disease Treatment & Types | NIAMS

  https://www.niams.nih.gov/health-topics/raynauds-phenomenon/basics/diagnosis-treatment-and-steps-to-take

  There are two types of Raynauds phenomenonprimary and secondary. The diagnosis between the two types is most commonly made with a device called nailfold capillaroscopy, where the doctor looks at your skin at the bottom of your fingernails under a microscope. […] The treatment depends on how serious the condition is and whether it is the primary or secondary form. […] In secondary Raynauds phenomenon, damage to the blood vessels from certain diseases, such as lupus or scleroderma, or work-related exposures are associated with the condition.

• #3 Raynaud’s – getting diagnosed | SRUK

  https://www.sruk.co.uk/raynauds/raynauds-getting-diagnosed/

  Raynaud’s phenomenon is often diagnosed by a GP based upon your symptoms and your medical history. […] It is likely that they will also arrange some blood tests, so that any underlying health conditions can be ruled out. […] Blood tests can be used to check for other health conditions that could be causing your symptoms. […] These tests may include: a full blood count to check for infection or, much less commonly, a cancer of the blood, such as leukaemia; an antinuclear antibodies (ANA) test to check for an overactive immune system, which is common in people with autoimmune conditions such as rheumatoid arthritis and lupus; erythrocyte sedimentation rate this test determines the rate at which red blood cells settle to the bottom of a tube. A faster than normal rate may signal an underlying inflammatory or autoimmune disease such as arthritis or lupus.

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