RAYNAUD'S PHENOMENA
RAYNAUD'S PHENOMENA: Excerpt from Algorithmic Diagnosis of Symptoms and Signs
Ask the Following Questions:
- Is there a history of drug ingestion? Ergotamine, methysergide, and beta-adrenergic receptor blockers are just a few of the drugs that may cause Raynaud's phenomena.
- Is there involvement of only one upper extremity? When there is involvement of only one upper extremity, thoracic outlet syndrome, especially cervical rib, arteriosclerosis of the subclavian artery, and embolism should be considered.
- Is there thickening of the skin? Thickening of the skin should bring to mind scleroderma.
- Is there hypertension? The presence of hypertension might suggest periarteritis nodosa and other collagen diseases, polycythemia vera, macroglobulinemia, cold agglutinins, and sickle cell anemia.
- Are there abnormalities of the blood cells, red cell mass, or serum proteins? These findings would suggest polycythemia vera, macroglobulinemia, cold agglutinins, and sickle cell anemia.
DIAGNOSTIC WORKUP
Routine diagnostic studies include a CBC, sedimentation rate, urinalysis, chemistry panel, serum protein electrophoresis, ANA titer, chest x-ray, and EKG.
If macroglobulinemia is suspected, a Sia water test and serum immunoelectrophoresis may be done. If cold agglutinins are suspected, a test for cold agglutinins may be done. A sickle cell preparation may be necessary if the patient is black. Collagen diseases may be further evaluated by skin and muscle biopsy and esophageal manometry.
Raynaud's phenomena may be demonstrated by immersing the hands in water at a temperature of 10° to 15°C. Whole body exposure to cold is an even better way of demonstrating the actual Raynaud's phenomena. The finding of nail-fold capillary-loop dilation and drop out may also help diagnose Raynaud's phenomena. If scleroderma is suspected, an antisclerodermal antibody titer is done.
Doppler studies and arteriography will rule out subclavian artery occlusions. A rheumatology or neurology consultation may be helpful.
Book Source Details
- Book Title: Algorithmic Diagnosis of Symptoms and Signs
- Author(s): R. Douglas Collins
- Year of Publication: 2003
- Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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