When should I consider referring a patient with Raynaud's phenomenon to a specialist?

Consider referring a patient with Raynaud's phenomenon to a specialist in the following situations:

• If there are signs of severe critical digital ischaemia, such as persistent skin colour changes or severe ischaemic pain, digital ulceration, necrosis, or severe tissue infection, arrange urgent hospital admission or referral to rheumatology or vascular surgery depending on clinical judgement.
• If there is suspected underlying cause or associated condition, such as connective tissue disease causing secondary Raynaud's phenomenon, refer to a rheumatology specialist with urgency based on clinical judgement.
• If the patient experiences frequent, severe episodes of Raynaud's phenomenon, consider rheumatology referral.
• If an occupational cause (e.g., hand-arm vibration syndrome) is suspected, refer to occupational medicine according to local pathways.
• For children aged 12 years or under with suspected Raynaud's phenomenon, or young people aged 13 to 17 years being considered for drug treatment, refer to a paediatrician or paediatric rheumatologist depending on clinical judgement and local pathways.
• If symptoms are poorly controlled, worsening, or unresponsive to optimal treatment in primary care, arrange specialist referral.
• If new clinical features suggest an underlying cause such as connective tissue disease, refer to a specialist.

These recommendations are based on expert consensus and UK guidelines emphasizing early specialist assessment to identify underlying diseases, manage severe complications, and optimize treatment outcomes ¹.