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Table 2 Early rheumatoid arthritis baseline work-up

From: Development of an interdisciplinary early rheumatoid arthritis care pathway

Laboratory investigations

Rationale

CBC

Evaluate for any baseline abnormalities including cytopenia (e.g., anemia of chronic disease, neutropenia)

Serology: RF, anti-CCP

Assist with the diagnosis and prognosis of early RA

Inflammatory markers: CRP, ESR *

Assist with ascertaining diagnosis and disease activity

Additional serology: ANA, ENA

May be warranted in certain clinical scenarios to ascertain overlap syndromes or alternative diagnoses

Renal function: creatinine/GFR, urinalysis

Identify pre-existing renal disease which could complicate therapy

Liver function: albumin, ALP, ALT

Identify pre-existing liver disease which could complicate therapy

Hepatitis screening: Hepatitis B Sag, Hepatitis B Sab, Hepatitis B Core, HCV

Identify pre-existing hepatitis which could complicate therapy

HIV

Depends on risk factors

QuantiFERON

Screen for tuberculosis

Imaging**

 

X-ray of hands/wrists

Identify damage from RA and evaluate any other findings indicative of an alternative diagnosis (e.g., psoriatic arthritis, gout, osteoarthritis)

X-ray of ankles/feet

Identify damage from RA and evaluate any other findings indicative of an alternative diagnosis (e.g., psoriatic arthritis, gout, osteoarthritis)

Chest X-ray

Screen for tuberculosis and other pre-existing lung pathology (e.g., ILD)

  1. Complete Blood Count (CBC), Rheumatoid Factor (RF), Anti Cyclic Citrullinated Peptide Antibody (anti-CCP), C-Reactive Protein (CRP). Erythrocyte Sedimentation Rate (ESR), Anti-Neutrophil Antibody (ANA), Extractable Nuclear Antigen (ENA), Glomerular Filtration Rate (GFR), Alkaline Phosphatase (ALP), Alanine Aminotransferase (ALT), Hepatitis C virus (HCV), Surface Antigen (Sag), Surface Antibody (Sab), Interstitial Lung Disease (ILD), Tuberculosis (TB)
  2. *Tested at the discretion of the attending rheumatologist
  3. **Additional imaging on a case-by-case basis