Why do general practitioners request rheumatoid factor? A study of symptoms, requesting patterns and patient outcome

Ann Clin Biochem 2003;40:131-137
doi:10.1258/000456303763046049
© 2003 Association for Clinical Biochemistry

 

This Article
Right arrow

Full Text (PDF)

Right arrow
Alert me when this article is cited
Right arrow
Alert me if a correction is posted
Services
Right arrow
Email this article to a friend
Right arrow

Similar articles in this journal

Right arrow
Similar articles in PubMed
Right arrow
Alert me to new issues of the journal
Right arrow
Download to citation manager
Right arrow
Citing Articles
Right arrow
Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow
Articles by Sinclair, D.
Right arrow
Articles by Hull, R. G.
Right arrow Search for Related Content
PubMed
Right arrow
PubMed Citation
Social Bookmarking

What’s this?

Original Articles


David Sinclair and
Richard G. Hull


Department of Chemical Pathology, Queen Alexandra Hospital, Portsmouth PO6 3LY, UK;
Department of Rheumatology, Queen Alexandra Hospital Portsmouth PO6 3LY, UK


Background: To investigate the reasons why general practitioners(GPs) request rheumatoid factor (RF) assays, we studied 200consecutive requests for RF from general practice in 1995.

Method: By means of an audit questionnaire, we studied 100 negative,50 positive and 50 borderline RF results and compared thesewith the presenting symptoms that prompted the request, theGPs’ understanding of the significance of the result, the referralintention and behaviour of the GP, and finally, the patientoutcome after 5 years.

Results: There was an 80% response rate. The presenting symptomsclosely matched the American Rheumatism Association revisedcriteria for the classification of rheumatoid arthritis, indicatingthat the requests were made on valid clinical grounds, withpolyarthralgia, morning stiffness and joint pain being the mostcommon. Most GPs considered a negative or positive result tobe meaningful, in that a positive RF meant that a referral wasmore likely than with a negative or borderline result, evenin the presence of appropriate symptoms in all three groups.Seventeen to thirty per cent felt that the test excluded orconfirmed RA. The result appeared to influence this decisionto a greater extent than it should. A 5-year follow-up on thesepatients showed that 26/40 patients with positive RF were referred,and that 25 of them developed a rheumatic disease of some kind,with 17 patients eventually being diagnosed with RA. Only 17/80patients with negative RF were referred, the remainder havingno autoimmune problem evident after 5 years, 11 of them developinga rheumatic disease, and only three being diagnosed with RA.

Conclusions: Although this is a locally based study, we believethe conclusions would be applicable to all laboratories andGPs undertaking these tests. RF requests are made on valid clinicalgrounds by GPs, but there may be an over-reliance on the resultsas regards referral behaviour. If patients were referred onclinical grounds, this would significantly lengthen consultants’waiting lists.


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What’s this?






This article has been cited by other articles:

Home page Ann Rheum DisHome page

V Nell-Duxneuner, K Machold, T Stamm, G Eberl, H Heinzl, E Hoefler, J S Smolen, and G Steiner
Autoantibody profiling in patients with very early rheumatoid arthritis: a follow-up study
Ann Rheum Dis,

January 1, 2010;
69(01):
169 – 174.

[Abstract]
[Full Text]
[PDF]


Home page Ann Rheum DisHome page

D E. Feldman, O Schieir, A J Montcalm, S Bernatsky, M Baron, and The McGill Early Inflammatory Arthritis Research G
Rapidity of rheumatology consultation for people in an early inflammatory arthritis cohort
Ann Rheum Dis,

November 1, 2009;
68(11):
1790 – 1791.

[Full Text]
[PDF]