Before your clinic appointment
In order to help prioritise and make the best possible use of your appointment / your patients’ clinic appointment , it would be really helpful if some investigations could be done in anticipation of the clinic appointment.
Suggested investigations where the following conditions are suspected are listed below.
Rheumatoid arthritis, psoriatic arthritis, reactive arthritis, undifferentiated arthritis
FBC, ESR, Full biochemical screen, CRP, Rheumatoid Factor, CCP antibodies, Antinuclear factor
- ESR or CRP can both be normal in up to 1/3 of patients at presentation
- Rheumatoid factor (and CCP antibodies) will be negative in 1/3 of patients.
If you need to put your patient on steroids while waiting for assessment, please send sample to lab before starting and try and taper steroids in anticipation of appointment.
Blood test screening can be very useful in determining prognosis.
FBC, ESR, U+E, LFT’s, CRP, HLA B-27 (where available), Xray Sacroiliac joints (MRI more sensitive though if you have access)
- ESR and CRP normal in 50% of patients with Ankylosing Spondylitis,
- 5% of healthy adults will be HLA B-27 positive and up to 20% of AS patients have a negative test.
If requesting MRI make sure you request scans of Sacroiliac joints. Lumbar spine scan relatively insensitive to AS (although may exclude other pathology).
e.g. suspected Fibromyalgia / Polymyalgia / Polymyositis
FBC, ESR, CRP, U+E, LFT’s, CPK, ANF, TFT’s, Myeloma screen if relevant.
Most patients with Raynauds have it in isolation but this is a useful screen where connective tissue disease suspected
FBC, ESR, CRP, U+E, LFT’s, TFT’s, Antinuclear factor (request scleroderma screen where suspected).
This is a useful screen for secondary causes of osteoporosis.
FBC, ESR, Full biochemical screen (including Bone profile), TFT’s, Vit D levels, Anti gliaden antibodies, myeloma screen.
Where hypercalcaemia or elevated Alk Phos present, check PTH levels (check with lab)
In addition to Uric acid test always a good idea to screen for metabolic syndrome / diabetes / hyperlipidaemia
FBC, ESR, CRP, Full biochemical screen, Uric acid (not routinely done in some labs as part of biochemical profile so needs to be requested specifically), Lipid profile, Fasting blood sugar / HbA1C.
Drug safety monitoring tests
Although recommended frequency can vary from drug to drug, most patients will require FBC, SMAC (liver and kidney tests) and a CRP is always useful.
Here's a list of frequently asked questions about appointments.
Dr Kavanagh has an interest in the management of inflammatory arthritis, osteoporosis.
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