Raynaud’s phenomenon (RP), is a disorder of the microvasculature that generally affects the fingers and toes but can present on other extremities such as the nose, ears and nipples.
Diagnostic Criteria for Primary Raynaud’s Phenomenon
- Meets 3 Step Criteria for diagnosis of Raynaud’s phenomenon
- Normal Capillaroscopy (e.g. clusters 1 and 2, which were described as “normal” and “perfect normal”)
- Physical examination is negative for findings suggestive of secondary causes, (e.g.ulcerations, tissue necrosis or gangrene, sclerodactyly, calcinosis, or skin fibrosis)
- No history of existing connective tissue disease
- Negative OR low titer ANA (e.g. 1:40 by indirect immunofluorescence)
Three-step approach to diagnosis of Raynaud’s Phenomenon
Step 1: Ask screening Question
Are your fingers unusually sensitive to cold?
Yes, proceed to step 2
Step 2: Assess color changes
Occurrence of biphasic color changes during the vasospastic episodes (white and blue)
Yes, proceed to step 3
Step 3: Calculate disease score
- Episodes are triggered by things other than cold (i.e. emotional stressors)
- Episodes involve both hands, even if the involvement is asynchronous and/or asymmetric
- Episodes are accompanied by numbness and/or paresthesias
- Observed color changes are often characterized by a well-demarcated border between affected and unaffected skin.
- Patient provided photograph(s) strongly support a diagnosis of RP.
- Episodes sometimes occur at other body sites (e.g. nose, ears, feet, and areolas).
- Occurrence of triphasic color changes during the vasospastic episodes (white, blue, red)
If 3 or more criteria met from Step 3 (a – g), then the patient has RP
- Stringer T, Femia AN. Raynaud’s phenomenon: Current concepts. Clin Dermatol. 2018 Jul – Aug;36(4):498-507. [Medline]
- Maverakis E, Patel F, Kronenberg DG, Chung L, Fiorentino D, Allanore Y, Guiducci S, Hesselstrand R, Hummers LK, Duong C, Kahaleh B, Macgregor A, Matucci-Cerinic M, Wollheim FA, Mayes MD, Gershwin ME. International consensus criteria for the diagnosis of Raynaud’s phenomenon. J Autoimmun. 2014 Feb-Mar;48-49:60-5. [Medline]
Created Aug 15, 2019.