A number of immunology tests are available to GPs. A positive test is significant only if the individual has symptoms.
| Symptoms | Tests to consider | Likely Rheumatic Condition | Comment |
| Inflammatory joint symptoms- pain, joint swelling, significant morning stiffness (>30-45min) | CCP | Rheumatoid arthritis (RA) | A positive CCP may be observed in healthy individuals without joint symptoms. It is not a diagnostic test for RAA negative CCP does not exclude RA |
| Sicca symptoms arthralgia/arthritis | ENA Rheumatoid factor | Sjogren’s Syndrome | Antibodies to Ro and La often observed in Sjogren’s |
| Muscle weaknessRaised CKSwallowing difficulty | ANA,ENA | Dermatomyositis/polymyositis | Inflammatory markers usually raisedSignificant CK rise( see myositis page) |
| Arthritis/arthralgiaPhotosentivityMalar rashMouth ulcersHair lossPleuritic chest pain Cytopenias | ANA,ENA | Lupus | A positive ANA can be seen in 30% of healthy people and is not diagnostic of SLE or other CTD. ANA should not be used to as a screening tool. |
| Secondary Raynaud’s Dyspnoea (ILD)SclerodactylyHeartburnTelangiectasia | ENA ANA | Systemic Sclerosis | Inflammatory markers often normal |
| Recurrent unexplained miscarriagesunexplained thromoembolic events | Lupus anticoagulant & anticardiolipin antibodies | Antiphospholipid syndrome | Haematology |
| Generally unwellPurpuric rashProteinuriaunexplained respiratory | ANCA | Systemic Vasculitis | Inflammatory markers raised |
M.A & H.B/S.R 25-01-24
Antibody testing should not be used as a screening test for rheumatological disorders. A good history will guide the tests undertaken. These conditions are managed by various specialities and symptoms/signs will also direct referral.
Who to refer:
- Only patients who have symptoms suggestive of an autoimmune inflammatory disorder
- If patient has clinical symptoms of an inflammatory arthritis, please refer straightaway instead of waiting for immunology
Who not to refer:
A patient with a positive ANA without symptoms should NOT be referred to Rheumatology
How to refer:
- SCI Gateway > Rheumatology > WGH
- If patient is systemically unwell with suspected lupus, myositis, vasculitis please discuss with the Rheumatology oncall team
Rheumatology RefHelp pages
