Raynaud's Phenomenon (cont.)
What are the symptoms and signs of Raynaud's phenomenon?
Symptoms of RP depend on the
severity, frequency, and duration of the blood vessel spasm. Most patients with
mild disease only notice skin discoloration upon cold exposure. They may also
experience mild tingling and numbness of the involved digit(s) that will
disappear once the color returns to normal. When the blood-vessel spasms become
more sustained, the sensory nerves become irritated by the lack of oxygen and
can cause pain in the involved digit(s). Rarely, poor oxygen supply to the
tissue can cause the tips of the digits to ulcerate. Ulcerated digits can
become infected. With continued lack of oxygen, gangrene of the digits
can occur.
Less common areas of the body that can be affected by RP
include the nose, ears, and tongue. While these areas rarely develop ulcers,
they can be associated with a sensation of numbness and pain.
Patients with secondary RP can also have symptoms related to
their underlying diseases. RP is the initial symptom of 70% of patients with
scleroderma, a skin and joint disease. Other rheumatic diseases frequently
associated with RP include systemic lupus erythematosus, rheumatoid arthritis,
and Sjogren's syndrome.
How is Raynaud's phenomenon diagnosed?
In patients with the characteristic sequence of skin-color changes of the digits upon cold exposure,
diagnosing RP is not difficult. Sometimes, certain patterns in the
tiny blood vessels (capillaries) adjacent to the fingernails of patients with RP
can be seen using a magnifying viewing instrument. Abnormal nail-fold capillary patterns can suggest
the possibility of an associated rheumatic condition. There is, however, no
single blood test to help the doctor to confirm the diagnosis. The doctor
can order certain blood tests (for example, sedimentation rate,
rheumatoid factor, antinuclear antibody, thyroid hormone levels, and protein
levels) to exclude associated rheumatic diseases and thyroid disorders. The doctor can also
perform certain maneuvers with the patient's extremities to exclude pinched
blood vessels that can produce symptoms that mimic RP, such as in thoracic outlet syndrome.
Typically patients with Raynaud's phenomenon that is a
manifestation of a rheumatic disease have elevated blood sedimentation rates and
antinuclear antibodies. Furthermore, capillary nail fold abnormalities can
frequently be found as described above.
Next: How is Raynaud's phenomenon treated? »
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