PT  - JOURNAL ARTICLE
AU  - Kam Shojania
TI  - Rheumatology: 2. What laboratory tests are needed?
DP  - 2000 Apr 18
TA  - Canadian Medical Association Journal
PG  - 1157--1163
VI  - 162
IP  - 8
4099  - http://www.cmaj.ca/content/162/8/1157.short
4100  - http://www.cmaj.ca/content/162/8/1157.full
SO  - CMAJ2000 Apr 18; 162
AB  - The case: A 32-year-old woman, consults her physician about generalized aches and pains in her limbs, low back and neck and intermittent headaches during the last 3 years. She experiences fatigue and sleep disturbance. Her hands have always turned red in the cold, and she describes her fingers as sometimes swollen. She has no morning stiffness, alopecia, photosensitivity, psoriasis, skin rash, dry eyes or dry mouth. She has not been able to work as a teacher for the last 4 months. Two years ago, her previous physician told her that, according to blood tests, she probably has systemic lupus erythematosus. She is not taking any medication and is otherwise healthy. The case: A physical examination reveals nothing remarkable except generalized tenderness, particularly in the fibromyalgia tender points. There is no evidence of joint inflammation. Previous investigations, ordered by another physician, included a complete blood count, a urinalysis and thyroid-stimulating hormone and creatinine levels; all were normal. An antinuclear antibody test was positive at a titre of 1:80 with a homogeneous pattern. Rheumatoid factor was positive at a titre of 1:20, complement C3 was 1.75 g/L and complement C4 was 0.13 g/L. What further investigations, if any, are warranted?