Diagnosis Of Raynaud's Phenomenon Research Articles

Raynaud's Phenomenon: A Current Update on Pathogenesis, Diagnostic Workup, and Treatment.

Raynaud's phenomenon (RP) is a condition characterized by episodic, excessive vasoconstriction in the fingers and toes, triggered by cold or stress. This leads to a distinctive sequence of color changes in the digits. Pallor indicates reduced blood flow due to oxygen deprivation, while erythema appears as reperfusion. RP can be primary, with no identifiable underlying cause, or secondary, associated with other conditions. These conditions include autoimmune diseases, most commonly systemic sclerosis, vascular diseases; and neurological conditions. While the exact cause of RP remains unclear, genetic and hormonal (estrogen) factors are likely contributors. The pathogenesis of RP involves a complex interaction between the vascular wall, nerves, hormones, and humoral factors, disrupting the balance between vasoconstriction and vasodilation. In primary RP, the vascular abnormalities are primarily functional. However, in secondary RP, both functional and structural components occur in blood vessels. This explains why digital tissue damage frequently occurs in secondary RP but not primary RP. Diagnosis of RP is primarily clinical. Recent advancements in imaging techniques have aided in diagnosis and monitoring, but nail fold capillaroscopy remains the gold standard for distinguishing between primary and secondary RP. If there are signs of acute ischemic injury, vascular imaging, particularly preoperatively, is crucial to rule out other vaso-occlusive conditions. Management of RP focuses on alleviating symptoms and preventing tissue damage. Vasodilator medications are the first-line treatment when general measures like warmth and stress management are not sufficient. Dihydropyridine calcium channel blockers (CCBs), such as nifedipine, are commonly used for vasodilation. Phosphodiesterase-5 inhibitors and prostaglandin analogs are alternative options for patients who do not respond to CCBs or have ischemic tissue damage. Bosentan, an endothelin-1 receptor antagonist, has shown effectiveness in treating and preventing digital ulcers, especially in patients with multiple ulcers. For severe cases, botulinum toxin injections or sympathectomy surgery can be used to control RP symptoms. However, botulinum toxin injections require repeated administration, and sympathectomy's long-term effectiveness is uncertain. Fat grafting is a promising surgical therapy for promoting healing and preventing tissue injury.

Relationship between nailfold videocapillaroscopic findings and cardiovascular risk factors

BackgroundNailfold Videocapillaroscopy (NVC) is a valuable tool in the differential diagnosis of Raynaud's phenomenon (RP), present in certain Rheumatic diseases (RD). Knowing that many people have cardiovascular risk factors (CVRF), the main objective was to demonstrate that CVRF and carotid plaques produce NVC alterations. MethodsCross-sectional unicentric study carried out from 2020 to 2023. Four groups were formed: subjects with RD and RP, participants with RD without RP, subjects with RP without RD and finally participants without RP or RD (study group). Each subject exhibiting CVRF presented only a single risk factor. The variables collected were: sociodemographic, CVRF (diabetes, tobacco, alcohol (ALC), obesity (OBE), dyslipidemia and arterial hypertension (AH)), diseases, RP, treatments, tortuosities and NVC alterations (ramified capillaries, enlarged capillaries, giant capillaries, haemorrhages and density loss) and carotid ultrasound (CU). Results402 subjects were included (76 % women, mean age 51 ± 16 years), 67 % had CVRF, 50 % RP and 38 % RD. Tortuosities were present in 100 % of CVRF participants. A statistically significant association was found between the presence of CVRF and all the NVC alterations: ramified capillaries (OR = 95.6), enlarged capillaries (OR = 59.2), giant capillaries (OR = 8.32), haemorrhages (OR = 17.6) and density loss (OR = 14.4). In particular, an association was found between giant capillaries with AH (p = 0,008) and OBE (p 〈0,001), and haemorrhages and density loss with ALC and OBE (p < 0,001). On the other hand, 40 subjects presented CU plaques (9.9 %), associated with enlarged capillaries (OR = 8.08), haemorrhages (OR = 4.04) and ramified capillaries (OR = 3.01). The pathological intima-media thickness was also associated with haemorrhages (OR = 3.14). ConclusionsThere is a clear association between CVRF and ultrasound atherosclerotic findings in carotid with NVC alterations. These findings are of special interest for a correct NVC interpretation and to avoid false positives in the diagnosis of primary and secondary RP.

Scleroderma and Raynaud Phenomenon: The Cold Truth Regarding the Use of Operative Management.

Raynaud phenomenon, with and without scleroderma, is a common vasospastic condition that manifests with extremity pain and skin discoloration. When conservative management fails, complications such as ischemia, ulceration, and gangrene may warrant surgical intervention. The purpose of this study was to determine the risk factors and use of surgical intervention in this population. A national insurance claims-based database with patient records from the Centers for Medicare and Medicaid Services was used for data collection. Patients with first diagnoses of Raynaud phenomenon, scleroderma, or both between 2005 and 2014 were identified. Primary outcomes included the presence of upper extremity amputation or vascular procedure, and history of amputation within 5 years of a vascular procedure. Secondary outcomes included hospital admissions, upper extremity wounds, and amputation within 1 year of diagnosis. The Raynaud phenomenon, scleroderma, and Raynaud phenomenon with scleroderma cohorts consisted of 161,300, 117,564, and 25,096 patients, respectively. A diagnosis of both Raynaud phenomenon and scleroderma increased the odds of upper extremity amputation by 5.4-fold, vascular procedure by 4.8-fold, and amputation within 5 years of a vascular procedure by 1.5-fold. Patients with Raynaud phenomenon or scleroderma alone were 3.1 and 5.6 times less likely to undergo amputation within 5 years of a vascular procedure, respectively. Patients with both Raynaud phenomenon and scleroderma have higher likelihoods of having upper extremity amputations, vascular procedures, and amputations following vascular procedures compared to each diagnosis alone. Vascular procedures are rarely being performed. Further research is necessary to establish a standard of care and determine whether early and more frequent intervention with vascular procedures can decrease amputation rates in this patient population. Risk, II.

P012 Raynaud's phenomenon: a primary care problem?

Abstract Background/Aims Despite an established awareness of Raynaud’s phenomenon (RP), defined as an episodic vasospasm of the arteries in the extremities, no studies have yet described the way in which the phenomenon is assessed and managed within a primary care setting. The primary aim of this study is to evaluate the way in which Raynaud’s Phenomenon commonly presents, is investigated, and managed within a UK general practice (GP); auditing concordance with the National Institute for Health and Care Excellence (NICE) Clinical Knowledge Summary (CKS) 2020 guidance. Methods An audit of 79 patients with a coded diagnosis of RP was completed at Green Lane Medical Centre, a Merseyside General Practice. Patient care was audited against standards within the NICE CKS. Results The patient group was comprised of 53 females (67.1%) and 26 males (32.9%). 89.9% (71/79) of patients have a working diagnosis of primary RP. Patient age at the time of audit: 4% aged 0-18; 29% aged 19-45; 30% aged 46-60; 37% aged 60+. 59.5% (47/79) of patients had 2 or more troubling symptoms of RP documented by their GP, with 12.7% (10/79) describing a classic triphasic colour change. Examination findings were documented for 55.7% (44/79) of patients and 27.9% (22/79) received an autoantibody screen. 26.6% (21/79) of patients were referred to secondary care, with 42.9% (9/21) of these referrals specifying an intention to rule out Secondary RP. Documentation available regarding patient management indicated that conservative advice was provided to 62.5% (40/64) of patients, the most common being a patient information sheet (26/64). Medical management was offered to 39.1% (25/64) of patients but was declined by 24.0% (6/25) of those to whom it was offered, with most (16/19) patients who were commenced on medical therapy discontinuing by the time of audit. In secondary care, 81.0% (17/21) of referred patients had further investigations, 57.1% (12/21) received reassurance before or after the investigations and conservative advice was the most common management. Conclusion This study suggests that GPs play a major role in the assessment and management of patients with RP; 73.4% (58/79) of patients were not referred to secondary care. Of those that were referred, the majority were due to worsening or severe symptoms, or suspected secondary RP, in line with the CKS guidance. Most patients present with 2 or more of the symptoms described in the NICE CKS guidance and the use of examination and screening blood tests in primary care appears to be the mainstay of assessment. In accordance with the CKS guidance, most patients are provided with information and lifestyle advice. High rates of medical therapy discontinuation suggest that assessment of severity of symptoms and improved patient education of medication side effects may play a role in determining the most appropriate candidates for medical therapy. Disclosure K.E. Winstone: None. M.E. Anderson: None. A.E. Stickland: None.

Raynaud's Phenomenon: A Vascular Acrosyndrome That Requires Long-Term Care.

Some 5-10% of the German population are affected by Raynaud's phenomenon (RP). In around 10-20% of cases RP arises from an underlying disease, most commonly a connective tissue disease. This review encompasses the diagnosis and differential diagnosis of RP and examines the efficacy of the currently available pharmaceutical and non-pharmaceutical treatment options. We conducted a selective literature search in PubMed using the search terms "Raynaud's phenomenon", "Raynaud's syndrome," "vasospasm," "vascular acrosyndrome," and "systemic sclerosis," together with a search of the Cochrane Database of Systematic Reviews up to April 2020. Raynaud's phenomenon mainly affects the fingers or toes and is typically triggered by cold or emotional stressors. The most important diagnostic steps are demonstration of a tendency towards digital vasospasm, exclusion of occlusions in the afferent arteries and acral vessels, nail-fold capillaroscopy, and determination of autoantibody status. Tumor screening should be arranged in the presence of B symptoms or first manifestation of RP in old age. The onset of RP in childhood is a rare occurrence and points to a secondary origin. The principal options for treatment are protection against cold and administration of calcium antagonists, which reduces the occurrence of RP by around 20-40 %. The treatment of RP in patients with systemic sclerosis is described in the recommendations of the European League Against Rheumatism (EULAR). At onset or after years of latency, patients with Raynaud phenomenon may have an underlying disease (most commonly a connective tissue disease). Long-term specialist care is necessary for asymptomatic patients with risk factors and for those with clinically manifest symptoms of an underlying condition alike.

How do patients define Raynaud's phenomenon? Differences between primary and secondary disease.

To examine how people define Raynaud's phenomenon (RP) based on their lived experiences and explore if differences exist depending on primary or secondary RP diagnosis. An international survey was sent to people with RP through health systems, foundations, and social media. Qualitative coding of responses to an open text question regarding one's own definition of RP was performed and themes were identified. The prevalence of themes among the sample and then comparisons between themes among people who self-reported primary versus secondary diagnosis of RP were performed. There were 1345 respondents from 45 countries (mean age 51.5 years, 93% female) who defined RP in their own words; 17% reported primary RP and 83% reported secondary RP (69% of secondary RP was scleroderma-related, n = 927). Over half defined their RP by describing the body parts affected, color changes, pain, and triggers or situations in which an episode occurs. Patients with primary RP more frequently defined RP in terms of its impact on function/quality of life and pain compared to those with secondary RP (34.5% versus 25.3%, respectively, p=0.004; 54.0% versus 46.8%, p=0.05). Patients with secondary RP more frequently included specific body parts, color change, the management of attacks, and other digital vascular complications in their definition of RP. We have identified differences in how people with primary and secondary RP define RP, in terms of how they feel and function. Our findings have implications for the domains of outcome measures for assessing RP within different patient populations. Key Points • Pain is more often mentioned in primary RP and color change in secondary RP. • Over 25% of patients included reduced the quality of life as part of their RP definition. • The concept of "attack" is used to define RP by only 2% of patients.

Perfusion Scintigraphy for the Evaluation of Patients with Raynaud's Phenomenon.

Raynaud's phenomenon (RP) is a functional vascular disorder, which can be defined as transient vasospasm of the peripheral arteries and arterioles in the affected areas exposed to the cold or other stress. The diagnosis of RP is mainly based on symptoms. Perfusion scintigraphy, with or without cold stimulation, can be used to evaluate RP. Studies with perfusion scintigraphy for RP have shown that patients with RP showed lower finger-to-palm ratio than patients without RP. Responses after cold stimulation were also different in patients with RP. Not only decreased perfusion or blood pool after cold stimulation but also paradoxically increased perfusion can be shown in patients with RP. Some studies have shown that primary and secondary RP can be differentiated by perfusion scintigraphy. Correlation between duration of disease and findings on perfusion scintigraphy was reported. Perfusion scintigraphy can show differences before and after treatment as well. However, the protocols for perfusion scintigraphy for PR vary among studies. The standard protocol of perfusion scintigraphy for RP should be established.

SAT0601 RELATIONSHIP BETWEEN BODY MASS INDEX AND NAILFOLD CAPILLAROSCOPY IN PRIMARY AND SECONDARY RAYNAUD’S PHENOMENON

Background:Raynaud’s phenomenon (RP) is a diffuse clinical manifestation (3-5% of general population) RP is often secondary to autoimmune systemic diseases, while the condition is classified primary if no underlying disorders can be found. A lower body mass index (BMI) was associated with a greater risk of developing RP, perhaps due to greatest sensivity to cold temperaturesObjectives:The objective of our study was to evaluate the association of BMI with clinical and capillaroscopic features in primary and secondary RP.Methods:Consecutive patients at the first access to a Rheumatology Outpatient Clinic over a 13 months period were screened to RP; nailfold videocapillaroscopy (NVC)was carried out and qualitative and quantitative assessment was performed. Diagnosis of RP was defined in patients who identified color pictures of witnessed attacks.Patients enrolled were screened for secondary causes of RP. RP was classified as primary when no abnormalities were found. Weight and height were collected in clinical records and patients were divided in 3 groups according to their BMI: underweight (BMI&lt;18.5 kg/m2), normal weight (BMI 18.5–25 kg/m2), and overweight (BMI &gt;25 kg/m2). Chi-square test to compare categorical variable and Parametric Student t-test to comparing mean values of normally distributed data were used. p&lt;0.05 was considered to be statistically significant.Results:RP was diagnosticated in 100 of 1416 patients (7.06%). Of these, 73 (10 M, 63F) accepted to undergo NVC. An autoimmune disease was found in 35 patients (47.9%), of which 2 were underweight, 14 normal weight and 19 overweight. Of 38 patients with primary RP,3 were underweight, 23 normal weight and 12 overweight. BMI was significantly higher in secondary RP (p=0.03). Overweight patients with secondary RP were older (p=0.01), but with a disease duration not statistically significant longer (p=0.26). In secondary RP, avascular areas and neoangiogenesis were founded only in overweight patients. Moreover,in secondary RP overweight was correlated with decreased capillary density (p=0-04). There was not association between BMI and capillaroscopic abnormalities in primary RP.Conclusion:In our study BMI was correlated with microvascular changes only in patients with secondary RP. Our findings may suggests a role for obesity in the microcirculatory disfunction in the autoimmune diseases. Further studies are needed to generalize results and to find a causative role.

Raynaud Phenomenon: Diagnosis and Management

ABSTRACT&#x0D; Raynaud’s phenomenon (RP) is a chronic episodic attack of digital ischemia provoked by exposure to cold or emotional stres. This phenomenon affects 3-5% of the population, with female ratio more than men and is categorized into a primary and secondary form. Primary form of RP is idiopathic, meanwhile the secondary form is associated with underlying diseases and other condition such as connective tissue disease, obstructive arterial disease, neurologic disorders, drugs and toxin, hyperviscosity disorders, infections, endocrine disturbance, neoplasms, and occupation or environmental exposure. Until today, to classified and build the diagnosis of RP is still a clinical challenge. Therefore, a careful history and a physical examination, together with laboratory tests and nailfold capillaroscopy are mandatory. A combination of conservative measures and medications can help in the management of RP. The approach to the RP patients requires therefore a coordinated care of specialists including dermatology.

Innovations in the Assessment of Primary and Secondary Raynaud's Phenomenon.

Objectives: Raynaud’s phenomenon (RP) is characterized by intense vasospasm of the digital arteries that causes characteristic color changes in fingers. There are two main types of RP: Primary RP (PRP) and Secondary RP (SRP). PRP is a benign condition. Whilst SRP is associated with several connective tissue diseases (CTD), in particular systemic sclerosis (SSc). The objectives of this report were: to present a short review on morphological (nailfold videocapillaroscopy, NVC) and functional techniques (laser tools and thermography) that allow for a correct diagnosis and treatment of RP and to investigate blood perfusion (BP) by laser speckle contrast analysis (LASCA) in different skin areas of hands and face in PRP, SRP to SSc, and healthy subjects (CNT).Methods: 31 PRP patients (LeRoy criteria), 70 SRP to SSc (ACR/EULAR criteria) and 68 CNT were enrolled. BP was assessed by LASCA at the level different areas of hands and face. NVC was performed to distinguish between PRP and SRP, and to detect the proper pattern of nailfold microangiopathy in SSc patients.Results: Both PRP and SRP showed a statistically significant lower BP than CNT at the level of fingertips (p < 0.0001), periungual (p < 0.0001), palmar aspect of 3rd finger (p < 0.0001), and palm areas (p < 0.0001). Moreover, BP was significantly lower in PRP than in SRP to SSc with the “Early” pattern of microangiopathy in the same areas as above (p < 0.04).Conclusion: By considering a small cohort of patients, BP of hands was found lower in PRP than in SSc patients with the “Early” NVC pattern of microangiopathy.

Comparison between thermal recovery in women with Raynaud's Phenomenon and not diagnosed women using thermography.

Thermography detects the infrared radiation emanated from bodies and transduces it in electrical analog signal. It has application as a complementary exam in several medical segments, including the reheating study to detect diseases like Raynaud's Phenomenon (RP). In this way, the aim of this study is to compare the heating behavior of the RP women and not diagnosed (ND) women for selection of diagnosis criteria. This retrospective study was undertaken in the city of Curitiba, Brazil. For the study, twenty-four volunteer women, with the age range of 30-70 years, were taken to participate of a survey, 12 of them have the clinical diagnostic of Secondary Raynauld's Phenomenon, and twelve women were not diagnosed. Volunteers answered an anamnesis and had the central body temperature measured. They were oriented to keep the hands free and to do not touch anything during 15 minutes for acclimatization. Then, the hands were immersed for 60 seconds in a container with water at 10 °C. New pictures were taken every five minutes during twenty minutes after the immersion. The heating curve of the right hand shows that RP women's hands are colder than ND women and are slower to reheat the temperature after cold stress. The ring (fourth finger) has a linear behavior in both hands. It was the coldest one and the slowest to reheat. Statistical difference was observed in critical times of reheating at 15 and 20 minutes after the cold stress. These results show that this finger could become a reference in studies to determine cutting points and to facilitate the clinical diagnosis of RP.

Infračervená termografie v diagnostice Raynaudova fenoménu - II. část

V navazujicim pokracovani prvni casti clanku je věnovana pozornost prakticke casti průběhu infracerveneho termografickehovysetřeni, výsledkům vysetřeni a take epidemiologickým udajům sledovaneho souboru pacientů s poruchami akralniho prokrveni.

Infračervená termografie v diagnostice Raynaudova fenoménu - I. část

Infračervená termografie v diagnostice Raynaudova fenoménu - I. část

RAYNAUD’S PHENOMENON: A MULTIDISCIPLINARY PROBLEM

Синдром Рейно широко распространен в популяции: его частота составляет в среднем 3–5%. Он подразделяется на первичный, с дебютом преимущественно в детском и подростковом возрасте, и вторичный, развивающийся в более старшей возрастной группе. Вторичный синдром Рейно ассоциируется с системными ревматическими заболеваниями, эндокринной и гематологической патологией, отдельными инфекциями. Он также может быть обусловлен экзогенными факторами. В этой связи данное состояние часто встречается в практике ревматологов, педиатров, инфекционистов, гематологов и врачей других специальностей. В лекции подробно излагаются современные подходы к диагностике и дифференциальной диагностике синдрома Рейно.

Raynaud’s phenomenon - assessment and differential diagnoses

Raynaud’s phenomenon (RP) is characterised by paroxysmal reversible episodes of vasospasm, usually involving peripheral small vessels of the fingers or toes and resulting in a triple-colour change starting with pallor and followed by cyanosis and erythema. Attacks are typically triggered by cold or emotional stress. The diagnosis of RP can be made on the basis of the patient’s clinical symptoms. Primary RP occurs without underlying disease and is considered a benign condition. A normal erythrocyte sedimentation rate, negative testing for antinuclear antibodies, normal nailfold capillaries and the absence of structural micro- or macrovascular damage and other diseases lead to the diagnosis of primary RP. Digital photoplethysmography and pulse contour analysis can be used as an additional tool to exclude structural macro- or microvascular disease. In contrast, secondary RP is associated with other diseases, mainly connective tissue diseases such as systemic sclerosis. If there is a suspicion of secondary RP, a thorough laboratory and vascular assessment is required to make the diagnosis of underlying disease. Acrocyanosis and erythromelalgia are additional functional vascular disorders that can be easily distinguished when patients are carefully assessed for their history and clinical symptoms.

Raynaud's phenomenon: new aspects of pathogenesis and the role of nailfold videocapillaroscopy.

Raynaud's phenomenon (RP) refers to paroxysmal pallor or cyanosis of the digits of the hands or feet and, infrequently, the tips of the nose or ears (acral parts) owing to cold-induced vasoconstriction of the digital arteries, precapillary arterioles, and cutaneous arteriovenous shunts.Raynaud's phenomenon reflects an exaggeration of normal central and local vasomotor responses to cold or emotion. Raynaud's phenomenon has been classified as primary or secondary, depending on whether it occurs as an isolated condition or is associated mainly with a connective tissue disease.Dysregulation of autonomic and sensitive nerve fibers, functional and structural vessel changes, and intravascular alterations can be observed in the pathogenesis of RP.Nailfold videocapillaroscopy (NVC) is the best non-invasive and repetitive diagnostic technique for detecting morpho-functional changes in the microcirculation. Nailfold videocapillaroscopy is accepted in early diagnosis and monitoring of primary and secondary RP.

SAT0321 The Absence of SSC Pattern at NFC Carries A 90% Negative Predictive Value for the Classification of Very Early or Established SSC in an Unselected Cohort of Patients with Raynaud's Phenomenon; Experience from A Single Tertiary Centre

BackgroundNail-fold capillaroscopy (NFC) patterns of vasculopathy have been well described in systemic sclerosis (SSc) but few studies have reported their predictive value in an unselected cohort of patients with Raynaud's...

Raynaud’s phenomenon in the rheumatologist’s practice

Raynaud’s phenomenon (RP) is a common condition that predominantly occurs among women. The onset age in most cases is under 30 years. The phenomenon was first described by M. Raynaud over 150 years ago. Primary (Raynaud’s disease) and secondary RP were subsequently distinguished. Pathophysiology of RP has not been fully elucidated yet; RP seems to be a multifactor disease. A pronounced vasospasm in response to stimuli is believed to be caused by disruption in the central and local mechanisms of regulation of vascular tonus. Vascular endothe- lial, intravascular, and neuronal disorders are the key ones among these factors. Structural changes in vessels that can be observed by nailfold capillaroscopy play a significant role in pathophysiology of secondary RP. The key step in the diagnosis of RP is identifying its clinical variant, since secondary RP may be a sign or a premonitory symptom of certain autoimmune, hematologic, endocrine, neoplastic, and other disorders. Secondary RP is most frequently observed in patients with systemic rheumatoid diseases. Therapy of secondary RP provides no satisfactory out- comes, since there is no complete conception about the pathophysiological mechanisms of its development. Different groups of drugs are cur- rently used to treat RP, including calcium channels blockers, phosphodiesterase type 5 inhibitors, endothelin receptor antagonists, etc. This review focuses on pathogenesis, the algorithm of early and differential diagnosis of RP, and current approaches to therapy based on the analysis of the published and our own data.

International consensus criteria for the diagnosis of Raynaud's phenomenon

Vasoconstriction accompanied by changes in skin color is a normal physiologic response to cold. The distinction between this normal physiology and Raynaud's phenomenon (RP) has yet to be well characterized. In anticipation of the 9th International Congress on Autoimmunity, a panel of 12 RP experts from 9 different institutes and four different countries were assembled for a Delphi exercise to establish new diagnostic criteria for RP. Relevant investigators with highly cited manuscripts in Raynaud's-related research were identified using the Web of Science and invited to participate. Surveys at each stage were administered to participants via the on-line SurveyMonkey software tool. The participants evaluated the level of appropriateness of statements using a scale of 1 (extremely inappropriate) through 9 (extremely appropriate). In the second stage, panel participants were asked to rank rewritten items from the first round that were scored as “uncertain” for the diagnosis of RP, items with significant disagreement (Disagreement Index > 1), and new items suggested by the panel. Results were analyzed using the Interpercentile Range Adjusted for Symmetry (IPRAS) method. A 3-Step Approach to diagnose RP was then developed using items the panelists “agreed” were “appropriate” diagnostic criteria. In the final stage, the panel was presented with the newly developed diagnostic criteria and asked to rate them against previous models. Following the first two iterations of the Delphi exercise, the panel of 12 experts agreed that 36 of the items were “appropriate”, 12 items had “uncertain” appropriateness, and 13 items were “inappropriate” to use in the diagnostic criteria of RP. Using an expert committee, we developed a 3-Step Approach for the diagnosis of RP and 5 additional criteria for the diagnosis of primary RP. The committee came to an agreement that the proposed criteria were “appropriate and accurate” for use by physicians to diagnose patients with RP.

AB0739 Infrared thermography of big toe in raynaud’s phenomenon

BackgroundThe thermography measures blood flow indirectly by measuring skin surface temperature [1]. The characteristic of Raynaud phenomenon is cold-induced vasoconstriction in distal extremities which in turn, lowers skin temperature.ObjectivesThe aim...