| 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. |
Capillaroscopy. Capillaroscopy is the most reliable way to distinguish between primary and secondary Raynaud's phenomenon through identification of an early pattern of systemic sclerosis. (PubMed) M. Cutolo. Best Pract Res Clin Rheumatol. Dec 2008. (Also see: Capillarscopy) |
| 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. |
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| Prince: Prognostic Index For Nailfold Capillaroscopic Examination For Identifying Raynaud's Phenomenon (RP) At High Risk Of Developing Into A Scleroderma Spectrum Disorder. Our prognostic capillaroscopic index identifies RP patients at high risk of developing scleroderma spectrum disorders. Our results suggest that this index could be used in clinical practice, and its further inclusion in prospective studies will undoubtedly help to explore its potential in predicting treatment response. F. Ingegnoli. SAT0421.EULAR 2008. |
| 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 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! | |
| 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) |
| 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. |
| 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. |
| 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) |
| 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. |
| 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 absolutely recommend it!"—Stephen (a fellow Raynaud's "sufferer"). |
| References |
| (1) Dr. Maureen Mayes. |
