cardiovascular disorders
Raynaud Syndrome
Diagnosis of Raynaud Syndrome
Clinical evaluation Examination and testing for underlying disorder Raynaud syndrome itself is diagnosed clinically. Acrocyanosis also causes color change of the digits in response to cold but differs from Raynaud syndrome in that it is persistent, not easily reversed, and does not cause trophic changes, ulcers, or pain. Primary and secondary forms are distinguished clinically, supported by vascular laboratory studies and blood testing. A thorough history and physical examination directed at identifying a causative disorder are helpful but rarely diagnostic. Findings suggestingprimary Raynaud syndromeare the following: Age at onset < 40 years (in two thirds of cases) Mild symmetric attacks affecting both hands No tissue necrosis or gangrene No history or physical findings suggesting another cause Findings suggestingsecondary Raynaud syndromeare the following: Age at onset > 30 years Severe painful attacks that may be asymmetric and unilateral Ischemic lesions History and findings suggesting an accompanying disorder Vascular laboratory testing includes measuring digital pulse wave forms and pressures. The main blood tests are to diagnose collagen vascular diseases (eg, measurement of erythrocyte sedimentation rate [ESR] or C-reactive protein, antinuclear and anti-DNA antibodies, rheumatoid factor, anticentromere antibody, anti-cyclic citrullinated peptide [CCP] antibodies, anti-scleroderma [SCL] 70 antibody) . 