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Rheumatoid arthritis - Management
Are investigations for suspected rheumatoid arthritis necessary in primary care?
- There is no specific diagnostic test for rheumatoid arthritis (RA). All people suspected of having RA should be referred for specialist assessment.
- If RA is suspected clinically, investigations are not necessary in primary care. However consider the following tests to speed up the diagnostic process, and act as a baseline measure prior to treatment:
- Full blood count, and C-reactive protein or erythrocyte sedimentation rate.
- Urea and electrolytes, liver function tests, calcium, and bone profile.
- Rheumatoid factor.
- Auto-antibodies (such as antinuclear antibodies).
- Radiography of the hands and the feet — if synovitis is affecting these joints.
- Chest radiography — to exclude lung involvement (which is common in RA).
- Anti-cyclic citrullinated peptide antibodies — usually a discussion with a specialist is necessary, depending on local policy and availability.
- Anti-CCP antibodies should only be done if the person is known to be rheumatoid factor negative and likely to be started on combination treatment.
- Ultrasound or magnetic resonance imaging (MRI) of joints — depending on local policy and availability.
- Do not let investigations delay a referral for clinically suspected RA.
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