Evaluation of the patient with presumptive Raynaud phenomenon

RP: Raynaud phenomenon; ANA: antinuclear antibody; TSH: thyroid-stimulating hormone; ESR: erythrocyte sedimentation rate; CRP: C-reactive protein; POEMS: polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, skin changes; GERD: gastroesophageal reflux disease.
* Nailfold capillary microscopy can be used to show abnormal capillary loops and/or dropout or loss of loops to suggest an underlying (or increased likelihood of developing a) systemic rheumatic disease; these changes will not be seen in patients with primary RP. However, nailfold microscopy is typically performed by specialists (eg, dermatology, rheumatology) and not always readily available.
¶ Examples of signs/symptoms suggestive of systemic disease include unexplained fever, arthralgias, myalgias, severe dysphagia, or refractory GERD. Signs of severe digital ischemia (eg, digital ulceration/gangrene) can also be associated with secondary RP. Digital ischemia is most likely due to secondary RP in these patients, but other causes of digital ischemia may contribute (eg, digital embolism, peripheral artery disease).
Δ Occupational exposures (chronic hand vibration, repetitive hand trauma, repeated handling of frozen foods), toxins (eg, polyvinyl chloride), and certain drugs (chemotherapeutic agents [eg, cisplatin, bleomycin], estrogen, interferon, vasoconstrictor agents [eg, ergotamine, nicotine, sympathomimetic agents among others]).
◊ If testing has been performed, negative serologies, normal ESR, and normal nailfold capillaries support a diagnosis of primary RP.
§ Refer to UpToDate content on additional laboratory testing and evaluation for secondary RP.
¥ Some exposures (eg, vibration) can aggravate symptoms in patients with primary RP.