Step 4: Tests, treatments
and further information
This step covers investigations that may be needed and additional information and treatments
At your first or second visit to specialist care to see the consultant rheumatologist and any other members of the team – you will usually meet the rheumatology nurse specialist – you may be asked to have additional tests, including blood tests and/or x-ray/ultrasound scan and have a Disease Activity Score taken. This may seem a bit confusing and bewildering to begin with, especially when you may be coming to terms with your diagnosis, but this is all quite normal and these tests will help your specialist team decide the best way forward in your treatment plan. This page covers the investigations that may be needed and additional information and treatments. Don’t be too concerned about the information on surgery as it is unlikely that this would be a consideration at this stage unless you have had inflammatory arthritis for a long time, untreated, and are only just getting a firm diagnosis.
The following topics will be covered in this step:
- Information on blood tests
- Joint Injections
- Information on Surgery
- Annual Review and national guidance for RA
- Information on X-Rays, Ultrasound and MRI
- Information on Biologics (Anti–TNF drugs for example adalimumab, etanercept, infliximab)
- NRAS article on anti-TNF treatment
- Patient Groups and Buddy System
Information on blood tests
Lab tests online
- offers the opportunity to find out more about all the commonly requested blood tests. Lab Tests Online-UK is written by practising laboratory doctors and scientists to help you understand the many clinical laboratory tests that are used in diagnosis and treatment.
NRAS article: Laboratory tests used in the diagnosis and monitoring of rheumatoid arthritis.
NRAS booklet: Newly Diagnosed – A guide to your next steps
– If you or someone close to you has been diagnosed with rheumatoid arthritis then this booklet is for you. Topics covered include: Being diagnosed, what rheumatoid arthritis is and how it can affect you, care and treatment
NRAS booklet: Managing Well – Living with rheumatoid arthritis
- If you're living with rheumatoid arthritis and you'd like to know more about how to manage your disease and stay in control, this booklet is for you. Its contents include - Self management: what it is and how it helps, making the most of your care and treatment, keeping well, including having a healthy diet and managing fatigue.
Patient.co.uk leaflet on joint injection
Information on Surgery
NRAS article on an overview of hand surgery in rheumatoid arthritis
NRAS article on surgery of the foot and ankle
NRAS article on elbow surgery
NRAS article on knee replacement surgery
NRAS article on hip replacements lasting longer
Arthritis Research UK article: Hand and wrist surgery
Annual Review and national guidance for RA
NRAS informaton on the DAS28 score (videos, booklets and article)
- The DAS28 is a measure of disease activity in rheumatoid arthritis (RA). The score is calculated by a complex mathematical formula, which includes the number of tender and swollen joints (out of a total of 28), the erythrocyte sedimentation rate (ESR, a blood marker of inflammation), and the patient’s ‘global assessment of global health' (indicated by marking a 10 cm line between very good and very bad). A DAS28 score greater than 5.1 implies active disease, less than 3.2 well controlled disease, and less than 2.6 remission.
NICE Guidance - RA in adults
- national guidelines for the treatment and management of RA
SIGN (Scottish) guidance on RA
- guidelines for those with living in Scotland
BSR guidelines: Management of rheumatoid arthritis (first 2 years)
- British Society for Rheumatology (BSR) guidelines
BSR guidelines: Management of rheumatoid arthritis (after first 2 years)
- British Society for Rheumatology (BSR) guidelines
ARMA Standards of Care in IA
– Arthritis and Musculoskeletal Alliance (ARMA) standards for people with inflammatory arthritis ie RA, psoriatic arthritis, ankylosing spondylitis and juvenile idiopathic arthritis (JIA)
Understanding NICE Guidance
- This booklet is about the care and treatment of adults with rheumatoid arthritis in the NHS in England and Wales. It explains guidance (advice) from NICE (the National Institute for Health and Clinical Excellence). It is written for people with rheumatoid arthritis but it may also be useful for their families or carers or for anyone with an interest in the condition.
BSR/BHPR Guidelines on Safety of anti-TNF
– British Health Professionals in Rheumatology (BHPR)
Information on X-Rays, Ultrasound and MRI
NRAS article on imaging techniques
- Information on imaging techniques such as x-ray, ultrasound, MRI and CT scans
Information on Biologics (Anti–TNF drugs for example adalimumab, etanercept, infliximab)
NRAS patient guide ‘Biologics, the story so far..
- a comprehensive guide to the biologic drugs including an individual description of all the drugs in this class which are currently prescribed in the U. There is also some background development of these drugs, about their mode of action and the criteria used in t their prescription. The booklet also contains information about the role of NICE and future management of RA.
NRAS booklet: Managing Well, Living with RA
– If you're living with rheumatoid arthritis and you'd like to know more about how to manage your disease and stay in control, this booklet is for you. Its contents include - Self management: what it is and how it helps, making the most of your care and treatment, keeping well, including having a healthy diet and managing fatigue.
NRAS article on anti-TNF treatment
NRAS article on abatacept (Orencia)
NRAS article on adalimumab (Humira) – FAQ
NRAS article on certolizumab pegol (Cimzia)
NRAS article on etanercept (Enbrel)
NRAS artcile on golimumab (Simponi)
NRAS article on infliximab (Remicade) – FAQ
NRAS article on rituximab (Mabthera)
NRAS article on tocilizumab (RoActemra)
Link to Electronic Medicines Compendium
- an online resource which gives access to the Patient Information leaflets (PIL) and the more detailed Summary of Product Characteristics (SPC) for all licensed drugs
Patient Groups and Buddy System
NRAS volunteer network
(peer to peer support) – if you would like to talk to someone else with RA then follow this link to find out about our telephone volunteers and how to access this service
NRAS patient support groups
– check to see if there is a group near you and find out more about their activities
Healthtalkonline information on bones and joints
- Healthtalkonline is a charity website, which features interviews with a wide range of people with personal experience of conditions of the bones and joints, so that you can share in their stories