Question
Age 42 female, new onset arthritis with warm swollen peripheral and central joints, warm, tender for 1 month unresponsive to doxcycline. family history: celiac sprue with associated arthritis symptoms social history: frequent traveler to area where Lyme disease endemic, has positive chronic titers. best diagnostic tests and plan?
Answer
Nothing replaces an in person consultation with a rheumatologist. Virtually all types of arthritis are diagnosed clinically– based on the history and physical exam. Bloodwork is ordered based on the clinical suspicions. However for efficiency, it is reasonable to have a rheumatoid factor, ANA, sedimentation rate and c-reactive protein done prior to the rheumatology consultation– but normal values should not prevent you from going ahead with the consultation.
