Diagnostic Tests for Raynaud's phenomenon
Raynaud's phenomenon: Diagnostic Tests
The list of diagnostic tests
mentioned in various sources as
used in the diagnosis of Raynaud's phenomenon
includes:
Raynaud's phenomenon Tests: Book Excerpts
Raynaud's phenomenon Diagnosis: Book Excerpts
Tests and diagnosis discussion for Raynaud's phenomenon:
Questions and Answers about Raynaud's Phenomenon: NIAMS (Excerpt)
If a doctor suspects Raynaud's phenomenon, he or she will
ask the patient for a detailed medical history. The doctor will then
examine the patient to rule out other medical problems. The patient
might have a vasospastic attack during the office visit, which makes it
easier for the doctor to diagnose Raynaud's phenomenon. Most doctors
find it fairly easy to diagnose Raynaud's phenomenon but more difficult
to identify the form of the disorder. (See the
box for the criteria doctors use to diagnose primary or secondary
Raynaud's phenomenon.)
Nailfold capillaroscopy (study of capillaries under a
microscope) can help the doctor distinguish between primary and
secondary Raynaud's phenomenon. During this test, the doctor puts a drop
of oil on the patient's nailfolds, the skin at the base of the
fingernail. The doctor then examines the nailfolds under a microscope to
look for abnormalities of the tiny blood vessels called capillaries. If
the capillaries are enlarged or deformed, the patient may have a
connective tissue disease.
The doctor may also order two particular blood tests, an
antinuclear antibody test (ANA) and an erythrocyte sedimentation rate
(ESR). The ANA test determines whether the body is producing special
proteins (antibodies) often found in people who have connective tissue
diseases or other autoimmune disorders. The ESR test is a measure of
inflammation in the body and tests how fast red blood cells settle out
of unclotted blood. Inflammation in the body causes an elevated
ESR.
Diagnostic Criteria for Raynaud's
Phenomenon
Primary Raynaud's Phenomenon
- Periodic vasospastic attacks of pallor or cyanosis (some
doctors include the additional criterion of the presence of
these attacks for at least 2 years)
- Normal nailfold capillary pattern
- Negative antinuclear antibody test
- Normal erythrocyte sedimentation rate
- Absence of pitting scars or ulcers of the skin, or gangrene
(tissue death) in the fingers or toes
Secondary Raynaud's Phenomenon
- Periodic vasospastic attacks of pallor and cyanosis
- Abnormal nailfold capillary pattern
- Positive antinuclear antibody test
- Abnormal erythrocyte sedimentation rate
- Presence of pitting scars or ulcers of the skin, or gangrene
in the fingers or toes
|
(Source: excerpt from
Questions and Answers about Raynaud's Phenomenon: NIAMS)
NHLBI, Raynaud's Phenomenon: NHLBI (Excerpt)
An attack
is usually temporary, so the doctor relies on the patient's description to
diagnose the problem. The doctor will also determine whether the patient has
Raynaud's alone (called primary Raynaud's phenomenon) or if another disease or
some aspect of the patient's lifestyle is causing the symptoms. If the problem
is caused by another disease or risk factor, the patient is said to have
secondary Raynaud's phenomenon.
(Source: excerpt from NHLBI, Raynaud's Phenomenon: NHLBI)
Diagnostic Tests for Raynaud's phenomenon: Online Medical Books
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Review excerpts from medical books online, free, without registration,
for more information about the diagnostic tests for Raynaud's phenomenon.
RAYNAUD'S PHENOMENA:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
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.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Raynaud's Phenomenon:
Physical examination
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
A. Focused physical examination (PE). The goal of the PE is to uncover sentinel markers for illnesses responsible for secondary RP. In primary RP, the physical examination should be normal. Evaluate for thoracic outlet syndrome, examine distal extremity pulses, and perform an Allen test. Signs of scleroderma, such as sclerodactyly or telangiectasia should be sought, and digital necrosis or ulceration should be identified.
B. Additional PE. If the history suggests an underlying connective tissue disorder, examine the heart, lungs, joints, skin, and nervous system.
Testing
A. Clinical laboratory tests. No “gold standard” test for RP exists. Evaluation is aimed at uncovering secondary causes and should include a complete blood count, erythrocyte sedimentation rate, and antinuclear antibodies (1).
B. Other tests. Angiography can be considered with evidence of vascular occlusive disease. Abnormal nailfold capillary microscopy is a reliable indicator of the presence of underlying connective tissue disorders or of the risk of developing such a disorder. It is a useful adjunctive test in cases where the distinction between primary and secondary RP is unclear. It is performed by placing a drop of immersion oil on the nailfold and observing the capillaries with an ophthalmoscope set at diopter 40. The absence of fine capillaries and the presence of markedly dilated or tortuous vessels are characteristic abnormal findings.
Diagnostic assessment
A history of typical color changes of the digits is essential in the diagnosis of RP. Characterization of the attack as primary or secondary RP is accomplished through history, PE, and basic screening laboratory tests. More than 85% of patients with RP have the primary form, but 10% of patients with apparent primary RP will manifest an underlying disorder an average of 10 years from the onset of their RP (5). Nailfold capillary microscopy and laboratory tests to confirm specific connective tissue diseases should be performed in those cases where a suspicion for secondary RP exists, such as RP onset after age 30, asymmetric digital involvement, prolonged attacks resulting in tissue injury, or abnormal screening laboratory test results. Periodic monitoring for transition to secondary RP in these patients is prudent.
References
1. Wigley FM, Flavahan NA. Raynaud’s phenomenon. Rheum Dis Clin North Am 1996;22:765–781.
2. Fraenkel L, Zhang Y, Chaisson CE, Evans SR, Wilson PWF, Felson DT. The association of estrogen replacement therapy and the Raynaud phenomenon in postmenopausal women. Ann Intern Med 1998:129:208–211.
3. Gasbarrini A, Massari I, Serricchio M, et al. Helicobacter pylori eradication ameliorates primary Raynaud’s phenomenon. Dig Dis Sci 1998;43:1641–1645.
4. O’Keeffe ST, Tsapatsaris NP, Beetham WP. Increased prevalence of migraine and chest pain in patients with primary Raynaud disease. Ann Intern Med 1992;116: 985–989.
5. Spencer-Green G. Outcomes in primary Raynaud phenomenon: a meta-analysis of the frequency, rates, and predictors of transition to secondary diseases. Arch Intern Med 1998:158:595–600.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Raynaud Phenomenon:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
Cold is the usual precipitant. A classic triphasic response, occurring in 20%, begins with sharply demarcated blanching of the extremities, followed by cyanotic (slate-blue) discoloration with a dull aching caused by vascular stasis. With rewarming, the digits become livid purple, then deep red. The radial pulse remains normal throughout. “White attacks” are consistent with true digital arterial closure whereas cyanosis or mottling may be caused by arteriovenous shunt closure or small arteriole vasospasm. Pain suggests severe tissue ischemia and an underlying disease. Raynaud phenomenon should be distinguished from the common phenomenon of cold hands or feet, without cutaneous color change.
Fever, arthralgias, or constitutional symptoms are subtle indicators of an emerging connective tissue disease. There may be a long interval between the initial appearance of Raynaud phenomenon and the diagnosis of a connective tissue disease.
Unilateral Raynaud phenomenon results from proximal vascular disease such as thoracic outlet syndrome or subclavian atherosclerosis. Unidigital Raynaud is due to trauma or embolism to the palmar artery.
Nailfold capillaries can be examined through a drop of oil using an ophthalmoscope set at 40 diopters. Enlarged or distorted capillary loops suggest an underlying connective tissue disease, or the potential to develop one. The findings below are for nailfold capillary microscopy in scleroderma, CREST, and mixed connective tissue disease.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Tracheal tugging [Oliver-Cardarelli phenomenon, Oliver sign]:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
If the patient isn't in distress, obtain a pertinent history. Ask about associated symptoms, especially pain, and about history of cardiovascular disease, cancer, chest surgery, or trauma.
Then examine the patient's neck and chest for abnormalities. Palpate the neck for masses, enlarged lymph nodes, abnormal arterial pulsations, and tracheal deviation. Percuss and auscultate the lung fields for abnormal sounds, auscultate the heart for murmurs, and auscultate the neck and chest for bruits. Palpate the chest for a thrill.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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