Prescreening Blood Tests
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 as follows;
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 strongly suspect rheumatoid arthritis please ring for urgent appt while waiting for labs
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.
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).
Generalised Myalgias (eg suspected fibromyalgia)
FBC, ESR, CRP, U+E, LFT’s, CPK, ANF, TFT’s, Myeloma screen if relevant.
FBC, ESR, CRP, U+E, LFT’s, TFT’s, Antinuclear factor.
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)
FBC, ESR, CRP, Full biochemical screen, Uric acid (not routinely done in some labs), Lipid profile, Fasting blood sugar.