Medical Management

Working with your healthcare team

Assembling your healthcare team to support and guide you is an important step in managing your arthritis. Here is what each health professional can do for you.

General practitioner (GP or local doctor)

Your GP is usually your main provider of health care. He or she should be your first point of contact for any concerns you have about your arthritis or other health issues. Your GP can help you coordinate your overall health care, including making referrals to specialists if needed. Your GP may also have a practice nurse. A practice nurse can provide information and coordinate your care with the other members of your healthcare team.

Medical specialists

Your GP can refer you to an appropriate specialist. Your GP may recommend a specialist for you, or you may wish to choose your own. Most specialists see patients either at public hospitals or in private clinics. They may charge a fee for your appointment if working outside the public hospital system. This fee may be partly or mostly reimbursed through Medicare. Check the likely costs when making an appointment. If cost is a problem, discuss this with your GP.

• Rheumatologist: A rheumatologist is a doctor who specialises in diagnosis and medical treatment of joint, muscle and bone disorders. You may be referred to a rheumatologist if the cause of your symptoms is unclear or if you have a type of arthritis that needs specialist care.
• Orthopaedic surgeon: An orthopaedic surgeon specialises in diagnosis and surgical treatment of bone, muscle and joint disorders. The surgeon will discuss your need for surgery and other management options with you.

Allied health professionals

The following health professionals may also help you manage your arthritis:

• Dietitians are experts in food and nutrition. They provide advice about healthy eating, weight loss and diets for medical conditions, such as diabetes.
• Exercise physiologists can give you advice about exercise, including the best types of exercise for your health and ability.
• Occupational therapists (OT) can show you ways to make activities of daily living, such as cooking and showering, easier and provide advice on useful aids or equipment.
• Pharmacists can help you to understand your medicines (both prescription and over-the-counter medicines) and how to use them safely and correctly.
• Physiotherapists can advise you on exercise, posture and ways to relieve pain. They may also use treatments to keep your joints and muscles flexible.
• Podiatrists specialise in conditions affecting the feet. They can help you with footwear, nail care and orthotics (shoe inserts).
• Psychologists can teach you ways to cope with any pain and difficult emotions you feel as a result of your arthritis.
• Rheumatology Nurses are nurses with a specialist knowledge in arthritis. They can provide you with education, support and advice on your diagnosis and on-going management of your disease.

Blood tests for arthritis

Blood tests can be useful to help diagnose some, but not all, types of arthritis. Always discuss your blood test results with your doctor.

What are blood tests used for?

Your doctor may use blood tests to help:

• confirm a diagnosis: Blood tests can help diagnose some types of arthritis.
• monitor disease severity and response to treatment: Your doctor may use blood tests to determine whether your arthritis is responding to the medicines you are taking.
• check for side effects from medicines: Some side effects of medicines do not cause any obvious symptoms until significant damage has been done. Your doctor may use blood tests to check for side effects before they become major problems.

Are all types of arthritis diagnosed by a blood test?

Not all forms of arthritis can be diagnosed by blood tests. For example, there are no blood tests to diagnose osteoarthritis or chronic back pain. Sometimes your doctor may use blood tests to help rule out other types of arthritis or other conditions that can cause similar symptoms.

Are there other ways to diagnose arthritis?

Examination of your joints by your doctor is the first, and one of the most important, ways of diagnosing arthritis. Your doctor will use blood tests to help confirm what they find on examination and from listening to your symptoms. Your doctor may also use a variety of other tests to help diagnose arthritis, including testing other body fluids (such as urine or joint fluid) and x-rays and scans (such as MRI).  However it is possible to make a diagnosis of arthritis without any blood tests or imaging.

What are the most common blood tests for arthritis?

There are a variety of blood tests your doctor may order. The blood tests used to check for common types of arthritis include:

• Erythrocyte sedimentation rate (ESR): This test measures the level of inflammation in the body, by measuring how fast red blood cells cling together, fall and settle (like sediment) in the bottom of a test tube over an hour. A high ESR suggests greater levels of inflammation in your body. However ESR tests do not tell the doctor exactly where in your body the inflammation is or what is causing it. ESR can also be affected by other conditions besides inflammation, so it is often used alongside other tests.
• C-Reactive protein (CRP): This test measures the level of inflammation in the body, by measuring the amount of a special type of protein in the blood. A high or increasing amount of CRP suggests you have an acute infection or inflammation in your body. If the CRP level in your blood drops, it can mean that you are getting better and inflammation is reducing. Like the ESR, the CRP test is not specific enough to diagnose a particular type of arthritis or disease.
• Anti-cyclic citrullinated peptide antibody (AntiCCP): These antibodies help diagnose RA. It is particularly useful in the early stages of RA or in borderline cases as it is a more specific test than the rheumatoid factor test. According to the American College of Rheumatology, approximately 95% of patients with a positive CCP will go on to develop RA. However, only about six out of ten people with early RA will test positive to CCP so your doctor will still use other tests and examinations to diagnose your condition.

• Rheumatoid factor (RF): The test for rheumatoid factor is commonly used to help diagnose rheumatoid arthritis. Rheumatoid factor is an antibody (a protein made by the body’s immune system). It is found in about eight out of ten people who have rheumatoid arthritis (RA), but about two out of 10 people with RA will never test positive for rheumatoid factor. Rheumatoid factor levels can also vary and the test results may be negative in the early stages or during inactive periods (remission) of RA. If you have symptoms of RA but your first rheumatoid factor test is negative, your doctor may order the test to be repeated. However a positive rheumatoid factor test does not always mean you have RA as there are several other conditions that can also give positive rheumatoid factor results. Healthy people without RA can also test positive for rheumatoid factor, particularly older people. This does not mean you will develop the condition.
• HLA typing: This test looks for the presence of certain genetic markers in the blood that seem to be associated with an increased risk of developing certain types of arthritis. For example, the marker HLA-B27 is commonly found in people with a form of spondyloarthritis (such as ankylosing spondylitis, reactive arthritis or psoriatic arthritis). However HLA-B27 is a perfectly normal gene and is present in 8% of the general population, including healthy people without spondyloarthritis. Other genetic markers such as HLA – DR4 are associated with an increased risk of rheumatoid arthritis.
• Antinuclear antibody (ANA): The ANA test is used to screen for autoimmune disorders. In particular, about 95% of people with systemic lupus erythematosus (SLE or lupus) have a positive ANA test. The ANA test may also be positive in other conditions, such as Sjogrens syndrome, scleroderma, Raynaud’s disease, mixed connective tissue disease and rheumatoid arthritis. A positive ANA test result may suggest an autoimmune disease but further specific testing is usually needed to make a final diagnosis. ANA test results can also be positive in up to one in ten healthy people without any known autoimmune disease.