Adults
Raynaud's phenomenon with secondary features
Raynaud's with digital ulcers or pitting, abnormal nailfold capillaries, a positive ANA with specific antibodies, or late onset.
What to look for
- Onset after about 30–40, asymmetric attacks, or thumb involvement
- Digital pitting scars, ulcers, or puffy fingers
- Abnormal nailfold capillaries (dilated loops, dropout, hemorrhages)
- Positive ANA, especially with anti-centromere, Scl-70 or RNA polymerase III
What to do
- Send ANA with pattern, an ENA panel including centromere and Scl-70, CBC, metabolic panel, ESR/CRP and urinalysis.
- Treat symptoms (warmth, smoking cessation, a dihydropyridine calcium channel blocker).
- Active digital ulcers are urgent. Critical ischemia or gangrene is emergent.
About this urgency level
Specialist evaluation helps, but these are usually less time-sensitive than new inflammatory arthritis or connective tissue disease.
Timeframes are typical targets. Local pathways, capacity and clinical judgment come first.