Raynaud Phenomenon Workup

Updated: Sep 06, 2017
  • Author: Heather Hansen-Dispenza, MD; Chief Editor: Herbert S Diamond, MD  more...
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Workup

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.

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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
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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. [27]

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. [28]

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