Approach Considerations

Raynaud phenomenon can be diagnosed on clinical grounds. Imaging studies, including thermography, isotope studies, and arteriography, have all been used, but none has proven superior to clinical assessment in office practice. However, patients with a fixed, nonreversible, cyanotic lesion require further evaluation of the vasculature.

Laboratory testing may be performed 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.

Laboratory Studies

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 possible renal impairment
Prothrombin time - To observe for any evidence of hepatic dysfunction
Activated partial thromboplastin time - To observe for any evidence of antiphospholipid antibody disorder or hepatic dysfunction
Serum glucose - To evaluate for diabetes
Thyroid-stimulating hormone - To test for thyroid disorders

Optional laboratory tests are as follows:

Antinuclear antibody - May be positive in autoimmune disorders and should be obtained in patients with features of these disorders
Serum viscosity - Elevated in hyperviscosity syndromes such as paraproteinemias
Serum creatine kinase - Elevated in muscle damage such as polymyositis and dermatomyositis
Rheumatoid factor - May be elevated in rheumatoid arthritis, other autoimmune disorders, and some forms of cryoglobulinemia (monoclonal proteins in multiple myeloma and Waldenström macroglobulinemia have an increased frequency of rheumatoid factor activity)
Hepatitis panel - Positive for hepatitis B or C virus infection in many patients with cryoglobulinemia
Cold agglutinins - Present in Mycoplasma infections and lymphomas
Heavy metal screen - To asses for neuropathic pain due to poisoning
Growth hormone - To evaluate for acromegaly
Plasma metanephrine testing or 24-hour urinary collection for catecholamines and metanephrines - To evaluate for pheochromocytoma
Leukocyte alkaline phosphatase - To evaluate for leukemias in appropriate patients
Antiphospholipid antibodies studies - Including dilute Russell viper venom studies, anticardiolipin antibodies, and anti-beta-1-glycoprotein-2 antibodies
Serum protein and urine electrophoresis - To evaluate for paraproteinemias
Flow cytometry or acidified serum lysis (Ham) test - To evaluate for paroxysmal nocturnal hemoglobinuria

Magnetic Resonance Imaging

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.^[35]

Visceral Raynaud phenomenon may exist in patients with systemic sclerosis. 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.^[36]

Treatment & Management

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Media Gallery

A 9-year-old with Raynaud phenomenon. Notice the discoloration of the fingers.
Photo of a patient with Raynaud phenomenon that resulted from working with a jackhammer. Courtesy of the CDC.
Raynaud phenomenon showing demarcation of color difference.

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Author

Heather Hansen-Dispenza, MD Rheumatology Fellow, University of Arizona College of Medicine

Heather Hansen-Dispenza, MD is a member of the following medical societies: American College of Physicians, American College of Rheumatology

Disclosure: Nothing to disclose.

Coauthor(s)

S Anita Narayanan, MD Fellow in Rheumatology, University of Arizona College of Medicine

S Anita Narayanan, MD is a member of the following medical societies: American College of Physicians, American College of Rheumatology, American Medical Association

Disclosure: Nothing to disclose.

Mayra Oberto-Medina, DO Fellow, Department of Rheumatology, University of Arizona

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Elliot Goldberg, MD Dean of the Western Pennsylvania Clinical Campus, Professor, Department of Medicine, Lewis Katz School of Medicine at Temple University

Elliot Goldberg, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology

Disclosure: Nothing to disclose.

Chief Editor

Herbert S Diamond, MD Visiting Professor of Medicine, Division of Rheumatology, State University of New York Downstate Medical Center; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital

Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, Phi Beta Kappa

Disclosure: Nothing to disclose.

Additional Contributors

Jeffrey R Lisse, MD, FACP Professor, Department of Internal Medicine, Chief, Section of Rheumatology, University of Arizona School of Medicine

Jeffrey R Lisse, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, American College of Rheumatology, American Geriatrics Society, Sigma Xi, The Scientific Research Honor Society

Disclosure: Received consulting fee from Genentech for consulting; Received consulting fee from Centacor for consulting; Received consulting fee from Novartis for review panel membership.

John Varga, MD Professor, Department of Internal Medicine, Division of Rheumatology, Northwestern University

John Varga, MD is a member of the following medical societies: American College of Physicians, American College of Rheumatology, Central Society for Clinical and Translational Research, Society for Investigative Dermatology

Disclosure: Nothing to disclose.