When is Raynaud's phenomenon truly a disease? Dr. Robert Spiera joins us to discuss the key clinical clues, the value of patient photos and nail fold capillary findings, and how to approach a positive ANA without a defined connective tissue disease. We review treatment options from warming strategies and medication review to calcium channel blockers, PDE-5 inhibitors, prostaglandins, and digital sympathectomy and highlight the finding that demands urgent attention: a painful, persistently blanched digit. Most importantly, we discuss the balance between treating serious vascular disease and avoiding unnecessary medicalization of a common phenomenon. 

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