Use of Rheumatologic Testing in Patients who Eventually Receive a Diagnosis of Rheumatoid Arthritis

Dilpreet K. Singh, MD; Jasdeep Badwal, MD; Ritika Vankina, MD; Santhi Gokaraju, MD; Jennifer Friderici, MS; Scott Halista, MD; Tara Lagu, MD, MPH


South Med J. 2019;112(10):547-550. 

In This Article


We identified 173 patients with RA, referred from 141 different PCPs. The Table demonstrates baseline patient characteristics. Of the 173 patients, 75.7% were seen at the PP, and 82.7% were women with a mean ± standard deviation age of 55.5 ± 18.6 years. The Figure shows laboratory tests ordered by the referring provider. Referring clinicians ordered ACPA in only 28.9% (95% CI 22.6–36.2) and RF in 41.0% (95% CI 33.9–48.6) of patients. Ordering of ACPAs varied nonsignificantly by presenting site (26.2% CHC vs 29.8% PP, P = 0.70). Radiological imaging was documented for 32.4% (n = 56) of patients, with x-ray being the most frequent (92.9%, or 52/56) and magnetic resonance imaging a distant second (12.5%, or 7/56). Functional ability was documented in only 2.3% (n = 4) of referred patients (95% CI 0.9–6.1).


Tests ordered in all RA patients (N = 173) by referring provider. Error bars represent 95% confidence intervals. ACPA, anti-cyclic citrullinated peptide antibody; ANA, anti-nuclear antibody; Anti-dsDNA, anti-double-stranded DNA antibody; Anti-SSA/Ro, Sjogren syndrome type A antigen; Anti-SSB/La, Sjogren syndrome type B antigen/lupus La protein; CBC, complete blood count; CMV, cytomegalovirus; CRP, C-reactive protein; EBV, Epstein-Barr virus; ESR, erythrocyte sedimentation rate; LFT, liver function test; RA, rheumatoid arthritis; RF, rheumatoid factor; UA, undifferentiated arthritis.

We collected some additional data that will be useful for hypothesis generation for future studies. Most patients (86.7%, n = 150) had a disease-modifying antirheumatic drug initiated immediately on presentation to a rheumatologist. The proportion of patients waiting ≥1 month for treatment did not vary significantly by ACPA testing (14.3% if ACPA was ordered vs 19.8% if ACPA was not ordered, P = 0.63); however, almost half (45.7%, or 37/81) of the patients with documented symptom duration had a gap of at least 1 year between their first symptom and referral to a rheumatologist.