Early diagnosis and treatment of rheumatoid arthritis (RA) is important in preventing long-term damage and disability. RA should be suspected largely on the basis of clinical findings, such as persistent joint pain, swelling, and stiffness. Further investigations, particularly in primary care, may contribute to the diagnosis. Rheumatoid factor (RF) is an autoantibody associated with RA and its presence has traditionally been used to support the diagnosis. However, RF has a low specificity in primary care and cannot be used to rule in or rule out disease.
Currently GPs should base diagnostic and referral decisions on clinical features; number and site of involved joints and elevated acute phase response, rather than serological tests.
This body of work is in collaboration with members of the Nuffield Orthopaedic Center, Oxford University Hospitals NHS Trust.
The ongoing work is building a body of evidence around the role (if any) for RF in the diagnosis of RA in primary care. Several further pieces of work are currently in process and we envisage these, collectively, to inform future practice on the diagnostic value of the RF in primary care.
- Autoimmune markers for the diagnosis of rheumatoid arthritis in primary care: primary care diagnostic technology update. Mahtani KR, Miller A, Rivero-Arias O, Heneghan C, Price CP, Thompson M, Plüddemann A, Luqmani R. Br J Gen Pract. 2013 Oct;63(615):553-4. doi: 10.3399/bjgp13X673919.
- Is rheumatoid factor useful in primary care? A retrospective cross-sectional study. Miller A, Mahtani KR, Waterfield MA, Timms A, Misbah SA, Luqmani RA. Clin Rheumatol. 2013 Jul;32(7):1089-93. doi: 10.1007/s10067-013-2236-0. Epub 2013 Mar 21.
PulseToday News – No need for rheumatoid factor testing, GPs told
News GPonline.com – Rheumatoid arthritis diagnosis delayed by reliance on key test, GPs told