| RAYNAUD'S:
MAIN MENU |
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| Raynaud's
Diagnosis |
| This page
was written by Shelley
Ensz, and has not yet been medically edited. Scleroderma
(SD) affects everyone differently. Just because something is
listed here does not mean an individual patient will ever experience
it. See Disclaimer. |
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| Do Your Fingers Ever
Turn White? |
 Raynaud's
is diagnosed simply by asking the patient if their fingers or toes ever turn
white. There are no blood tests to diagnose it, although the
majority of patients who have an associated autoimmune disease will also
have autoantibodies or other evidence of inflammation in their
blood. |
| Heavy burden of cold hands disease. People suffering from Raynaud’s disease, which manifests itself with extremely cold hands, wait an average of six years before seeking medical advice, a startling new survey found. IrishHealth.com. 11/28/07. |
| Nailfold Capillaroscopy |
| Nailfold Capillaroscopy is used
by some doctors. A drop of oil is put on the nailfolds and
then looked at under a magnifying glass to see whether there
are changes in the capillaries which are indicative of connective
tissue disease. |
| Includes excellent photos of nailfold abnormalities --> |
The Handheld Dermatoscope as a Nail-Fold Capillaroscopic Instrument. The presence of nail-fold capillary abnormalities may be useful in diagnosing several connective tissue disorders, including scleroderma, dermatomyositis, and mixed connective tissue disease, and in differentiating primary Raynaud phenomenon from Raynaud phenomenon due to scleroderma and mixed connective tissue disease. Archives of Dermatology. Vol. 139 No. 8, August 2003. (Also see: Common Medical Tests) |
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| Scoring the nailfold microvascular changes during the capillaroscopic analysis in systemic sclerosis patients. The capillaroscopic score was found to be a sensitive tool to quantify and monitor the SSc microvascular damage. Furthermore, the microangiopathy evolution score might be used to survey the evolution of the microvascular damage, as the relative scores increase during the progression of the SSc. (PubMed) Sulli A. Ann Rheum Dis. 2008 Jun;67(6):885-7. (Also see: Capillaroscopy) |
| Scleroderma Skin Involvement: Fingernail, Nailfolds, and Cuticles. The systemic forms of scleroderma can cause the fingernails to become smaller, and cuticles to become hard or rough. But because there are so many possible causes of poor fingernail or cuticle condition, they are not part of the diagnostic criteria for any form of scleroderma. ISN. |
| Scleroderma patients nailfold videocapillaroscopic patterns are associated with disease subset and disease severity. Nailfold videocapillaroscopy, a simple, non-invasive and non-expensive investigation, is useful in staging scleroderma patients and also provides prognostic information. Rheumatology 2007 46(10):1566-1569. (Also see: Prognosis and Mortality) |
| Transition From Primary To Secondary Raynaud’s Phenomenon (PRP / SRP): Identification By Nailfold Videocapillaroscopy During The Follow-Up. We showed the progression from PRP to SRP in 14.6% of the analyzed patients. We suggest the capillaroscopic analysis twice a year in presence of PRP, in order to early detect the transition to SRP in patients showing at the beginning a normal pattern or not-specific nailfold capillary abnormalities, as assessed by NC. A. Sulli OP0138 EULAR 2007. (Also see: Raynaud's) |
| Nail changes in connective tissue diseases: do nail changes provide clues for the diagnosis? Proximal nailfold is the most important site of affection in CTDs. These nail changes can be used in combination with highly sensitive diagnostic modalities to establish an accurate diagnosis. PubMed. J Eur Acad Dermatol Venereol. 2007 Apr;21(4):497-503. (Also see: Common Medical Tests and Fingernails) |
| Raynaud's
phenomenon. Raynaud's phenomenon is the acrosyndrome
most commonly encountered by rheumatologists. The diagnosis
of Raynaud's phenomenon rests on clinical grounds. Nailfold
capillaroscopy and immunological tests are useful chiefly
for determining the cause. Acrocyanosis, which is extremely
common, and erythromelalgia are the other main vascular acrosyndromes. PubMed.
Joint Bone Spine. 2006 Dec 4. |
| Nailfold
Capillaroscopic Findings in Systemic Sclerosis Patients. Nail
fold capillaroscopy performed in a routine clinical setting,
without any special measurement, is an inexpensive and useful
technique in patients with clinical suspicion of SSc diagnosis,
and may identify patients with severe visceral complications.
Beatriz E. Joven. 1874/546 ACR 2006. (Also see: Common
Medical Tests) |
| Nailfold
Capillaroscopic Findings in Systemic Sclerosis and Raynaud
Phenomenon in a Rheumatology Clinical Setting. Nailfold
capillaroscopy performed in a routine clinical setting, without
any special measurement, is a simple and useful technique
for patients with Raynaud’s phenomenon and may help
to identify those patients with SSc diagnosis. Atusa Movasat.
1148/407 ACR 2006. (Also see: Common
Medical Tests) |
| Nailfold
capillaroscopy is useful for the diagnosis and follow-up
of autoimmune rheumatic diseases. A future tool for the analysis
of microvascular heart involvement? Architectural disorganization,
giant capillaries, haemorrhages, loss of capillaries, angiogenesis
and avascular areas characterize >95% of patients with
overt scleroderma (SSc).PubMed. Rheumatology (Oxford).
2006 Oct;45 Suppl 4:iv43-iv46. (Also see: Common
Medical Tests) |
| The
Prognostic Value of Nailfold Capillary Changes for the Development
of Connective Tissue Disease in Children and Adolescents
with Primary Raynaud Phenomenon: A Follow-up Study of 250
Patients. Children and adolescents who developed scleroderma
spectrum disorders showed a sclerodermatous type of capillary
changes 6 months before the expression of the disease. PubMed.
Pediatr Dermatol. 2006 Sep-Oct;23(5):437-42. (Also see: Juvenile
Scleroderma) |
| Nailfold
Capillaroscopic Findings in Systemic Sclerosis Patients. Nailfold
capillaroscopy is a useful technique in patients with clinical
suspicion of SSc diagnosis, and may identify patients with
severe visceral complications. B. Joven. FRI0360 EULAR
2006. (Also see: Diffuse
Scleroderma) |
| Inflammatory
myopathies in childhood: correlation between nailfold capillaroscopy
findings and clinical and laboratory data. Nailfold capillaroscopy
is an important tool for the diagnosis and follow-up of patients
with rheumatic diseases, in particular dermatomyositis and
scleroderma. A relationship has been observed in adults between
improved capillaroscopic findings and reduced disease activity. PubMed. J.
Pediatr (Rio J). 2006 January/February;82(1):40-45. (Also
see: Juvenile
Scleroderma and Dermatomyositis) |
| Capillaroscopy
in the diagnosis of systemic sclerosis. A characteristic
microangiopathy, so-called "scleroderma pattern capillary
abnormalities", are present in the majority of patients
with systemic sclerosis and already appear in the early stage
of the disease. Thus capillarosopy is considered a practical
tool for diagnosing and monitoring patients with systemic
sclerosis. PubMed. Postepy Hig Med Dosw (Online). 2005
Jul 11;59:340-5. (Also see: Medical
Tests for Scleroderma) |
| Capillaroscopy. Correlations
are evident between the nailfold video-capillaroscopic pattern
and the clinical symptoms, severity of the disease and the
laboratory findings. PubMed. Best Pract Res Clin Rheumatol.
2005 Jun;19(3):437-52. |
| Computerized
Nailfold Video Capillaroscopy—A New Tool for Assessment
of Raynaud's Phenomenon. By allowing access to previous
measurements, the new system should improve reliability in
longitudinal studies, and therefore has the potential of
being a valuable outcome measure of microvessel disease/involvement
in clinical trials of scleroderma spectrum disorders. J
Rheumatol. 2005 May;32(5):841-8. |
| Cold Stimulation Test |
Do not let your doctor dunk your hands in ice water to test for Raynaud's!
It is painful, unnecessary and possibly even dangerous! |
Some doctors run a Cold Stimulation
Test which involves taping a heat sensor to your hand, then
submerging them in an ice-water bath to measure how long it
takes to return to normal temperature. Needless to say, this
test is not very popular with Raynaud's patients as it is both
painful and unnecessary. It is also hazardous if you have gangrene
or open, infected wounds on your hands. No tests are required to diagnose Raynaud's! |
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| No Tests Required
to Make Diagnosis |
| No laboratory, radiological,
or Doppler tests are required to make the diagnosis
of Raynaud's. Such tests are actually best used to assess the severity,
and guide treatment. |
| Skin Properties |
| In
vivo study of skin mechanical properties in Raynaud's phenomenon (RP). Mechanical properties of the skin in patients with suspected secondary RP significantly differ from these in patients with primary RP and resemble
those in patients with edematous phase of scleroderma. Our findings
suggest that the non-invasive measurements of skin elasticity could
be helpful in identifying patients with RP at risk of developing SSc. PubMed. Skin Res Technol. 2007 Feb;13(1):91-4. |
| Vascular Laboratory
Testing |
| Many different tests may be run
in a vascular lab to assess the severity of Raynaud's. They
may measure blood pressure in each finger, test your response
to cooling and rewarming, and use heated Doppler's. |
| Abnormal digital neurovascular response to local heating in systemic sclerosis. Thermal hyperaemia could be monitored as a clinical test for neurovascular function in SSc. Further studies are required to test whether the abnormal digital neurovascular response correlates to the degree of peripheral vascular involvement. M. Roustit. Rheumatology 2008 47(6):860-864. |
| Elevated Plasma Adrenomedullin (ADM) and Vascular Manifestations in Patients with Systemic Sclerosis (SSc). Patients who had both severe Raynaud's Phenomenon (RP) and elevated pulmonary arterial pressure were found to have significantly higher ADM levels than patients who had neither manifestations and those with severe RP alone. Elevated ADM was found in SSc patients with increased pulmonary arterial pressure regardless of concomitant interstitial lung disease. J Rheumatol 2007;34:2224-9. (Also see: Pulmonary Hypertension) |
| Hand Vascular Involvement Assessed By Magnetic Resonance Angiography In Systemic Sclerosis. These results show the substantial specific vascular involvement in SSc. Lesions were diffuse and involved both arterial and venous vessels of small caliber and the microcirculation. Hand MRA appears to be a promising non invasive tool to evaluate the vascular aspects of SSc. Y. Allanore OP0165 EULAR 2007. |
| Maximum blood flow and microvascular regulatory responses in systemic sclerosis (SSc). SSc patients have abnormal microvascular regulatory responses compared with primary Raynaud's phenomenon and controls. This study also suggests that the degree of endothelial dysfunction may be related to the degree of peripheral vascular involvement. Rheumatology Volume 46, Number 7 Pp. 1079-1082. |
| Assessment
of Hand Vascular Involvement by Magnetic Resonance Angiography
in Systemic Sclerosis. All the patients had at least
one abnormality on MRA; lesions are generally diffuse and
involve both arterial and venous systems. No difference was
established among the 2 cutaneous sub-types but lesions seem
to increase with disease duration; however, some lesions
may be found as early as the initial months after diagnosis. Yannick
Allanore. 1882/554 ACR 2006. (Also see: Common
Medical Tests) |
| A
cold-response index for the assessment of Raynaud's phenomenon. The
results provide a solid basis for using the cold-response
assay as an endpoint in addition to clinical activity scores
in RP treatment trials. PubMed. J Dermatol Sci. 2006 Dec
12. |
| Space-Age
Bandage Device Lets Doctors Monitor Patients With Raynaud's
Disease. A small group of APL researchers, in collaboration
with physicians from the Johns Hopkins Scleroderma Center
in Baltimore, developed and recently completed initial trials
for a miniature device, worn on a patient's finger, to help
physicians characterize Raynaud’s disease and measure
treatment effectiveness. ScienceDaily. 02/02/07. |
| Local
hyperemia to heating is impaired in secondary Raynaud's phenomenon. Thermal
hyperemia is dramatically altered in patients with secondary
RP in comparison with subjects with primary RP. Further studies
are required to determine the mechanisms of this altered
response, and whether it may provide additional information
in a clinical setting. Arthritis Res Ther. 2005;7(5):R1103-12. |
| Related Books |
| Raynaud's
Phenomenon by Jay D. Coffman Get the most up-to-date
knowledge concerning Raynaud's! "If you, or someone
you know, has been diagnosed I (a fellow Raynaud's "sufferer")
absolutely recommend it!"—Stephen |
| References |
| (1) Dr.
Maureen Mayes. |
