development of Raynaud's phenomenon (RP) at an older age (i.e. > 30 years old), and particularly in males, suggests the possibility that RP is secondary to some underlying connective tissue disease (CTD), and this should prompt investigation for an underlying cause
RP occurs in more than 90% of patients with systemic sclerosis and in up to 40% of cases with systemic lupus erythematosus and idiopathic inflammatory myositis
other additional features that makes a secondary cause of RP more likely include:
digital ulceration, or year-round symptoms
abnormal nail fold capillaries (viewed with an ophthalmoscope with the +20 lens)
asymmetric upper limb pulses or bruits
puffiness/tightness of the finger skin
elevated ESR
positive ANA or other antibodies (Ro/La/Scl-70 etc)
Reference:
1) Arthritis Research Campaign (2000). Rheumatic Disease In Practice, September 2000, 3.
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