[Minimal etiological evaluation of Raynaud's phenomenon. 102 cases]

Area of Science:

• Rheumatology
• Immunology
• Diagnostic Medicine

Background:

• Raynaud's phenomenon (RP) necessitates early detection of underlying systemic diseases, particularly systemic scleroderma.
• Current diagnostic approaches may be invasive, complex, or costly, prompting the need for a simplified, effective screening protocol.
• Identifying early-stage systemic scleroderma is crucial for timely intervention and improved patient outcomes.

Purpose of the Study:

• To evaluate the efficacy of a minimal, non-invasive, and cost-effective investigation program for diagnosing the cause of Raynaud's phenomenon.
• To determine if a specific set of tests can reliably identify patients requiring further, more extensive investigations.
• To establish a screening protocol that can differentiate idiopathic RP from secondary causes, including connective tissue diseases.

Main Methods:

• A prospective study involving 102 consecutive patients presenting with Raynaud's phenomenon.
• Implementation of a minimal investigation program comprising physical examination, antinuclear antibody (ANA) screening, capillaroscopy, and hand/chest radiography.
• Comparison of results from the minimal program with comprehensive investigations covering multiple organ systems.

Main Results:

• The minimal program (physical examination, ANA screening, capillaroscopy) identified abnormalities in 96.5% of non-idiopathic Raynaud's phenomenon cases.
• Adding radiography increased detection to 98.8%, though this difference was not statistically significant.
• Idiopathic RP was diagnosed in 15 patients, secondary RP (including 29 systemic scleroderma cases) in 50, and suspected cases in 37.

Conclusions:

• A minimal investigation program (physical examination, ANA screening, capillaroscopy) is highly effective in diagnosing non-idiopathic Raynaud's phenomenon.
• Negative results from these three initial tests can obviate the need for more extensive and costly investigations.
• This simplified approach facilitates early detection of systemic diseases associated with Raynaud's phenomenon, enabling timely management.