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Kim's investigations

    Test Results
    FBC Hb 111 g/L
    MCV 90 fL
    WBC 9 x 109/L
    Platelets 250 x 109/L
    U&Es Normal
    ESR 15 mm/hr (Normal)
    CRP  6 mg/L (Normal) 
    HbA1c 32 mmol/mol
    Urine dipstick tests for blood/protein/glucose Negative
    Rheumatoid factor 8 IU/mL
    Anti-cyclic citrullinated peptide (anti-CCP) antibodies not in primary care 
    Antinuclear antibody not indicated as symptoms not suggestive of connective tissue disease at this stage 

    The results of Kim's investigations show that she has normal inflammatory markers and negative rheumatoid factor although her history is suggestive of an inflammatory arthritis.

    A normocytic anaemia is a common finding in inflammatory arthritis. Kim's case highlights the limitations of investigations in ruling inflammatory arthritis in or out. Negative blood tests can falsely reassure clinicians and patients causing delays in referral, diagnosis and initiation of disease-modifying treatment.

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    Investigations for musculoskeletal pain

    Man having an injection in his arm

    Investigations can be most useful to maximise the benefit of the patient's first outpatient appointment and to add certainty to a case that you think is non-inflammatory or manageable in primary care.

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