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Diagnosis of Raynaud's

Author: Shelley Ensz. Scleroderma is highly variable. See Types of Scleroderma. Read Disclaimer
Raynaud's Diagnosis Overview
Primary Raynaud's
Nailfold Capillaroscopy
Cold Stimulation Test
No Tests Required for Diagnosis
Magnetic Resonance Angiography (MRA)
Vascular Lab Testing
References

Raynaud's Diagnosis Overview

Do your fingers or toes 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. (Also see: What is Raynaud's?, What is Scleroderma?, Types of Scleroderma, and Systemic Sclerosis)

Primary Raynaud's

Primary Raynaud's = Raynaud's by itself, with no other illness causing it.
This is also known as Raynaud's Disease.
Primary Raynaud's. When Raynaud's appears by itself, without any other medical condition, it is called Primary Raynaud's, or Raynaud's Disease. More than 80% of people with Raynaud's have it by itself, not caused by any serious underlying illness. ISN.
Overview
Nailfold Cap. for Primary Raynaud's
Nailfold Capillaroscopy vs. Doppler
HRQOL with Primary Raynauds
Seconday Raynaud's

Seconday Raynaud's

Secondary Raynaud's = Raynaud's due to another illness.
This is also known as Raynaud's Phenomenon.
Secondary Raynaud's. When Raynaud's appears along with autoimmune diseases such as scleroderma, systemic lupus erythematosus, or rheumatoid arthritis, it is called Secondary Raynaud's, or Raynaud's Phenomenon. ISN.
Overview
Diagnosis of Primary vs Secondary
Raynaud's Secondary to Scleroderma
Raynaud's Secondary to Other Diseases

Nailfold Capillaroscopy

Nailfold Capillaroscopy is the best way to tell if someone has primary or seconday Raynaud's. Capillaries are very tiny blood vessels. Capillaries are very close to the surface of the skin, particularly near the base of fingernails. ISN.
Overview
Handheld Dermatoscope Works, Too
Primary Raynaud's & Capillaroscopy
Secondary Raynaud's & Capillaroscopy
Photos of 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.

Cold Stimulation Test

Diagnosis of Raynaud's Phenomenon (RP) by 99mTc-Hydroxymethylene Diphosphonate Digital (Tc-HDP) Blood Flow Scintigraphy After One-hand Chilling. 99mTc-HDP digital blood flow scintigraphy after one-hand chilling is a noninvasive, accurate, and quantitative method to evaluate RP. Seong-Ryul Kwan. JRheum. June 16 2009.
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!

No Tests Required to Make Diagnosis

No tests are required to make the diagnosis of Raynaud's. Laboratory, radiological, or Doppler tests are best used to assess the severity of the disease and as a guide for treatment.

Magnetic Resonance Angiography (MRA)

Micro magnetic resonance angiography of the finger in systemic sclerosis. Micro-MRA can be used to identify and quantitatively characterize the vascular disease in SSc fingers. The parameters derived from micro-MRA could potentially be used as prospective biomarkers for clinical evaluation. Wang J, Yarnykh VL, Molitor JA. Rheumatology (Oxford) 2008 Aug; 47(8):1239-43.

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.
Freezing Fingers Syndrome, Primary and Secondary Raynaud's Phenomenon (RP): Characteristic Features with Hand Thermography. RP should be suspected when differences between mean temperatures of the metacarpus and digits are ≥to 3ºC. PubMed, Acta Derm Venereol, 2013 Jul 6;93(4):428-32.
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)
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.

References

(1) Dr. Maureen Mayes.
 
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