Evaluation of the patient with Raynaud's phenomenon.

Idiopathic Raynaud's phenomenon (Raynaud's disease) is very common among young women. A thorough history and physical examination are the keys to determining the extent of a diagnostic workup. In an otherwise normal and asymptomatic young woman with vasospastic attacks involving symmetric aspects of the digits, a CBC, urinalysis, chest film, and ESR are recommended as a cost-effective workup. If these studies are negative, the disease is probably benign. A history or physical findings consistent with collagen vascular disease, obstructive arterial disease, or carpal tunnel or thoracic outlet syndrome should lead to selected diagnostic tests. Men, persons with onset of vasospastic attacks after age 40, and those with severe disease or trophic changes of the digits deserve a more comprehensive workup to screen for underlying causes.