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.
Diagnostic Criteria for Raynaud's PhenomenonDoctors use certain diagnostic criteria to diagnose primary or secondary Raynaud's phenomenon.
Criteria: Primary Raynaud's Phenomenon
The diagnostic criteria used to diagnose primary raynaud's phenomenon include:
- Periodic vasospastic attacks of pallor (whiteness) or cyanosis (blueness) (Note: 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 (ANA)
- Normal erythrocyte sedimentation rate (ESR)
- Absence of pitting scars or ulcers of the skin, or gangrene (tissue death) in the fingers or toes
Criteria: Secondary Raynaud's Phenomenon
The diagnostic criteria used to diagnose secondary raynaud's phenomenon include:
- Periodic vasospastic attacks of pallor (whiteness) and cyanosis (blueness)
- Abnormal nailfold capillary pattern
- Positive antinuclear antibody test (ANA)
- Abnormal erythrocyte sedimentation rate (ESR)
- Presence of pitting scars or ulcers of the skin, or gangrene in the fingers or toes
Diagnostic Tests for Raynaud's Phenomenon
Several diagnostic tests may be ordered by your doctor to help confirm a Raynaud's diagnosis.
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).
Antinuclear Antibody Test (ANA)
The antinuclear antibody test (ANA) test determines whether the body is producing special proteins (antibodies) often found in people who have connective tissue diseases or other autoimmune disorders. Patients with these connective tissue diseases or other autoimmune disorders, make antibodies to the nucleus, or command center, of the body's cells. These antibodies are called antinuclear antibodies and are tested for by placing a patient's blood serum on a microscope slide containing cells with visible nuclei. A substance containing fluorescent dye is added which binds to the antibodies. Under a microscope the abnormal antibodies can be seen binding to the nuclei.
Erythrocyte Sedimentation Rate (ESR)
The erythrocyte sedimentation rate (ESR) is a diagnostic test for inflammation. The erythrocyte sedimentation rate (ESR) test is a measure of inflammation in the body and tests how fast red blood cells settle out of unclotted blood by measuring the rate at which the red blood cells fall to the bottom of a tube over time. An increased sedimentation rate corresponds to increased non-specific inflammation in the body. It is often called a "sedrate" for short.
Cold Stimulation Test
The cold stimulation test is another test that your doctor might use to diagnose Raynaud's phenomenon. A cold stimulation test measures the temperature of each finger after being submerged in an ice-water bath. Heat sensors are attached to your fingers and temperatures are recorded until your finger temperature measures the same as it was before being placed in the ice-water bath.
What Research Is Being Conducted To Help People Who Have Raynaud's Phenomenon?
Researchers are studying ways to better diagnose Raynaud's phenomenon and predict and monitor its course and association with other diseases. They are also evaluating the use of new drugs to improve blood flow in Raynaud's phenomenon. Researchers in scleroderma and other connective tissue diseases are also investigating Raynaud's phenomenon in relation to these diseases.