Raynaud phenomenon

Thanks to Aaron for a great case! This was an elderly patient with a longstanding history of Raynaud phenomenon with acute onset of small purpura on the pads of this person’s toes who underwent a fairly comprehensive workup with likely primary Raynaud phenomenon.

Main points:

  1. ) Secondary Raynaud has a wide differential including rheum, hematologic/ vascular, drugs and other conditions. See below.
  2. ) The differential for secondary Raynaud should be suspected in a person who develops symptoms older, has abnormal nailbed capillaroscopy and/ or other systemic symptoms.
  3. ) Interestingly this patient had a low ESR which has a differential including clotting of the blood sample, hypofibrinogenemia, RBC membrane defects, CHF, amongother things (see this great paper from Adam Obley: Annals 1986; 104:515-523)

Want to learn more?

Raynaud phenomenon ddx

Rheumatologic

  • MCC systemic sclerosis, RA, SLE, Sjogren syndrome, Antisynthetase syndrome, MCTD

Heme

  • Cryoglobulinemia, Hypercoagulable state (eg APLA)
  • Vascular: embolic/ thrombotic, vasospasm

Drugs

  • Cocaine, Sympathomimetics, Chemotherapy (eg cisplatin, bleomycin, vinca alkaloids, gemcitabine)

Other

  • Hypothyroidism
  • Carpal tunnel syndrome
  • Frostbite

Here is a great NEJM and recommendation regarding how to approach Raynaud phenomenon.

Inflammatory markers for diagnosis

Thanks to Adam Obley here are two great papers one from the Journal of Pediatrics and another a systematic review of 9 studies that essentially concludes that there is no big increase in added utility in obtaining both ESR and CRP for inflammatory or infectious conditions and the over-testing adds up to significant amounts to the healthcare system