Raynaud’s disease is a condition that causes some areas of the body to feel numb and cold in response to cold temperatures or stress. The fingers, toes, nose, and ears are most commonly affected. Testing for Raynaud’s involves looking for symptoms and using various tests to rule out other causes.
What are the symptoms of Raynaud’s?
The main symptom of Raynaud’s is color changes in the skin in response to cold temperatures or stress. The affected area will first turn white, then blue, and finally red as blood flow returns. The color changes are sometimes painful. Other symptoms include:
- Numbness or tingling in the affected areas
- Sensation of coldness in the fingers or toes
- Color changes lasting longer than a few minutes
- Color changes triggered by cold temperatures or emotional stress
- Fingers or toes alternating between red and blue
- Sores or ulcers on the tips of the fingers or toes (in severe cases)
What tests help diagnose Raynaud’s?
There is no single definitive test for Raynaud’s disease. Doctors often use a combination of the following tests to aid diagnosis:
Medical History
Looking at a person’s detailed medical history can help rule out other conditions with similar symptoms and identify any associated conditions. The doctor will ask about:
- Onset, frequency, duration, and severity of color changes
- What triggers the attacks
- Which parts of the body are affected
- Any accompanying symptoms like pain, numbness, or tingling
- Impact on daily activities
- Other existing medical conditions
- Family history of Raynaud’s or autoimmune disorders
Physical Exam
A physical exam allows the doctor to check for signs of Raynaud’s such as:
- Visible color changes in the skin
- Delayed capillary nail bed refill
- Skin ulcers or sores
- Skin thickness or texture changes
- Abnormal nerve sensitivity
- Signs of associated autoimmune or connective tissue disorders
Cold Stimulation Test
This test uses cold water or air to see if it triggers the characteristic color changes. One hand is immersed in cold water for about 10 minutes while the doctor monitors skin temperature and color.
Nail Fold Capillaroscopy
This test uses a microscope to examine the tiny blood vessels at the base of the fingernails. Changes in the appearance of these capillaries can help confirm Raynaud’s diagnosis.
Blood Tests
Blood tests may help rule out other conditions like thyroid disorders, abnormal proteins, or clotting disorders. Common tests include:
- Complete blood count
- ESR (erythrocyte sedimentation rate)
- Antinuclear antibodies
- Thyroid function
- Serum protein electrophoresis
Imaging Tests
Imaging such as CT scan, MRI, ultrasound, or angiography can check blood vessel anatomy for abnormalities. This may be done if there are concerns about an underlying condition causing secondary Raynaud’s.
How is Raynaud’s classified?
There are two main classifications of Raynaud’s:
Primary Raynaud’s
This is the most common type, accounting for 80-90% of cases. It occurs on its own, without an associated medical condition. Women under age 40 are most commonly affected. It is typically milder than secondary Raynaud’s.
Secondary Raynaud’s
This type occurs as a result of an underlying disease or condition. Connective tissue disorders like scleroderma, lupus, or Sjogren’s syndrome are often involved. Other associated diseases can include atherosclerosis, thyroid disorders, carpal tunnel syndrome, and certain cancers. Secondary Raynaud’s tends to be more severe with higher risk of complications.
What are the complications of Raynaud’s?
For many people with primary Raynaud’s, symptoms are mild and do not progress. But for some, complications can include:
- Skin ulcers – Long term reduction of blood supply can cause skin sores or ulcers, typically on fingers and toes.
- Nerve damage – Prolonged ischemia (low oxygen) can injure nerves in the affected areas, causing numbness or pain.
- Gangrene – In rare severe cases, extreme tissue damage can lead to gangrene requiring amputation of the affected digits.
- Heart attack or stroke – If Raynaud’s is caused by an underlying arterial disease, the blood vessel abnormalities increase risk of blood clots.
People with secondary Raynaud’s related to connective tissue diseases are more likely to experience complications than those with primary disease.
What is the treatment for Raynaud’s?
The goals of Raynaud’s treatment are to reduce frequency and severity of attacks and prevent tissue damage or complications. Treatments can include:
Avoiding Triggers
Staying warm, protecting skin from cold, and managing stress can help reduce Raynaud’s attacks.
Medications
- Calcium channel blockers – Drugs like nifedipine relax blood vessels and decrease attacks.
- Alpha blockers – Help relax small arteries and improve blood flow.
- Vasodilators – Open up constricted blood vessels.
- Prostaglandins – Improve blood vessel supply.
Biofeedback
Biofeedback uses relaxation techniques to help people gain voluntary control over involuntary body responses. This can reduce frequency of Raynaud’s attacks.
Surgery
For severe cases that do not respond to other treatments, surgical procedures may help improve blood flow. This includes sympathectomy to interrupt overactive nervous signals and blood vessel repair procedures.
What is the long-term outlook for Raynaud’s?
The long-term outlook depends on whether Raynaud’s is primary or secondary:
- For primary Raynaud’s, the condition is unlikely to progress or cause serious complications when properly managed. Attacks may reduce in frequency over decades.
- Secondary Raynaud’s has potential to get worse over time. Proper treatment is needed to prevent serious complications. Overall outlook depends on the underlying disease.
While Raynaud’s itself is not life-threatening, the resultant tissue damage can be damaging over time. Seeking proper diagnosis and following treatment guidelines can help prevent progression and maintain quality of life.
Key Points
- Raynaud’s causes cold-induced color changes and numbness in the extremities.
- Diagnosis involves medical history, physical exam, cold stimulation test, nail fold capillaroscopy, and blood tests.
- Primary vs secondary Raynaud’s refers to whether an underlying condition is present.
- Complications like skin ulcers, nerve damage, and gangrene are possible.
- Treatment aims to avoid triggers, control symptoms, and prevent progression.
- Prognosis is generally good with proper management but secondary Raynaud’s has higher risks.
