Article Text

SP0077 Differential Diagnosis between Primary and Secondary Raynaud's Phenomenon
  1. V. Smith,
  2. on behalf of the EULAR Study Group on Microcirculation in Rheumatic Diseases
  1. Rheumatology, Ghent University Hospital, Ghent University, Ghent, Belgium


Clinical rheumatologists frequently get patients with Raynaud's phenomenon (discoloration of extremities upon exposure to cold or stress) referred. The challenge is to distinguish patients with a primary Raynaud's phenomenon (not connected to any connective tissue disease) from patients with a secondary Raynaud's phenomenon (due to a connective tissue disease).

A large 20-year follow-up study (Koenig Arthritis Rheum 2008) of patients presenting at baseline with merely the Raynaud's phenomenon and no sign of a connective tissue disease has taught the scientific community that if a CTD is to develop in such a population then it is systemic sclerosis. Subsequently it makes sense to screen for SSc in a Raynaud's phenomenon population.

In 1992 LeRoy and Medsger proposed criteria to distinguish primary from secondary Raynaud's phenomenon. Retrospective validation of these criteria allow correct classification of a patient in one clinical consultation in 89%. Amongst other criteria, a “normal” capillaroscopy is obligatory to be able to speak of a “primary” Raynaud's phenomenon. Conversely patients with a secondary RP due to SSc have the combination of a SSc-specific antibody and a scleroderma pattern on capillaroscopy.

These criteria have prospectively been validated. The triade of RP, SSc-specific antibody and scleroderma pattern on capillaroscopy has a high positive predictive value for the development of SSc, whilst the absence of SSc-specific antibodies and a scleroderma pattern has a high negative predictive value for the non-occurrence of SSc.

Disclosure of Interest None declared

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