Last reviewed: 5 Nov 2021
Last updated: 25 Nov 2020

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • splenomegaly
  • joint deformities

Other diagnostic factors

  • rheumatoid nodules
  • hepatomegaly
  • history of vasculitis
  • frequent skin and respiratory tract infections

Risk factors

  • rheumatoid arthritis (RA) >10 years
  • family history of RA
  • age >50 years
  • white ethnicity

Diagnostic investigations

1st investigations to order

  • FBC
  • peripheral blood smear
  • serum erythrocyte sedimentation rate
  • serum CRP
  • LFTs
  • serum rheumatoid factor

Investigations to consider

  • serum antinuclear antibodies
  • serum anti-cyclic citrullinated peptide (anti-CCP) antibodies
  • ultrasound of abdomen
  • CT scan of abdomen
  • chest x-ray
  • bone marrow biopsy
  • virological tests

Treatment algorithm

Contributors

Authors

Dobrina N. Hull, MA, MRCP, PhD
Dobrina N. Hull

Consultant Rheumatologist

Kingston Hospital

Kingston upon Thames

UK

Disclosures

DH declares that she has no competing interests.

Gerald Coakley, PhD, FRCP
Gerald Coakley

Consultant Rheumatologist

Queen Elizabeth Hospital

London

UK

Disclosures

GC is the author of one reference cited in this topic. GC has been reimbursed by Novartis to attend an educational conference in the UK.

Peer reviewers

Simon Bowman, PhD, FRCP

Consultant Rheumatologist and Honorary Senior Clinical Lecturer in Rheumatology

Selly Oak Hospital

Birmingham

UK

Disclosures

SB declares that he has no competing interests.

Alice Klinkhoff, MD, FRCPC

Medical Director

Mary Pack Arthritis Program

Clinical Associate Professor

University of British Columbia

Vancouver

BC

Canada

Disclosures

AK is the author of a study referenced in this topic.

Alan Bridges, MD

Professor and Vice Chair

Department of Medicine

University of Wisconsin Hospital

Madison

WI

Disclosures

AB declares that he has no competing interests.

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