ALAIN SARAUX, BRUNO FAUTREL, JEAN FRANCIS MAILLEFERT, RENÉ MARC FLIPO, OLIVIER KAYE, PIERRE LAFFORGUE, KATELL GOURVES, FRANCIS GUILLEMIN, and the Club Rheumatism and Inflammation
Objective. To conduct a practice survey of laboratory and imaging studies used by French rheumatologists to identify the cause of recent-onset arthritis.
Methods. We selected a random sample of 210 rheumatologists, who were asked to recruit all patients with recent-onset arthritis (at least one joint involved, for less than one year) during a 2 week period, and to record laboratory and imaging studies performed. Results were analyzed in the overall group, in diagnostic subgroups, and in clinical presentation subgroups.
Results. The 119 rheumatologists who participated recruited 104 patients. Investigations done in ≥ 75% of patients were blood cell counts; erythrocyte sedimentation rate; serum assays of C-reactive protein, rheumatoid factors, antinuclear antibodies; and hand radiographs. Investigations in 50% to 74% of patients were serum ASAT/ALAT, creatinine, and uric acid; and foot radiographs. Finally, 25% to 49% of patients were tested for proteinuria; antikeratin antibodies; hepatitis B, hepatitis C, and Lyme serologies; creatine phosphokinase; blood iron; HLA-B27; and radiographs of chest and pelvis. No differences were found between investigations in patients with suspected rheumatoid arthritis and/or undifferentiated arthritis and those in other patients. In contrast, suspected diagnoses and presence of extraarticular manifestations classically associated with specific diseases modified the selection of investigations.
Conclusion. Although considerable variability occurred, our study suggests that a limited panel of laboratory and imaging studies is performed in at least 25% of patients with recent-onset arthritis, regardless of clues suggesting a specific diagnosis. (First Release April 1 2006; J Rheumatol 2006;33:897–902)
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From the Rheumatology Units of the Brest, Dijon, Paris La Pitié, Lille, and Marseille La Timone Teaching Hospitals, France; Rheumatology Unit, Liège Teaching Hospital, Liège, Belgium; and the School of Public Health, Nancy, France.
A. Saraux, MD, PhD; K. Gourves, MD, Rheumatology Unit, Brest; J-F. Maillefert, MD, Rheumatology Unit, Dijon; B. Fautrel, MD, Rheumatology Unit, Paris La Pitié; R.M. Flipo, MD, Rheumatology Unit, Lille; O. Kaye, MD, PhD, Rheumatology Unit, Liège Teaching Hospital; P. Lafforgue, MD, Rheumatology Unit, Marseille La Timone; F. Guillemin, MD, PhD, School of Public Health, Nancy.
Address reprint requests to Prof. A. Saraux, Rheumatology Unit, CHU Cavale Blanche Hospital, Brest Teaching Hospital, BP 814, F29609 Brest Cedex, France. E-mail: Alain.Saraux@univ-brest.fr
Accepted for publication December 14, 2005.