Blood tests and diagnostic imaging

The following routine blood tests are recommended by the German interdisciplinary FMS guideline for patients with CWP (potential differential diagnosis are indicated in parentheses):

• blood sedimentation rate, C-reactive protein, red and white cell blood count (polymyalgia rheumat-ica, rheumatoid arthritis)

• creatinine kinase (muscle disease)

• calcium (hypercalcemia)

• thyroid-stimulating hormone (hypothyreosis)

• depending on history and examination, further blood tests can be necessary if other differential diagnoses are suspected.

Without cinical signs, routine testing for antibodies associated with inflammatory rheumatologic diseases is not recommended. A Canadian study in outpatient secondary care found no predictive value of the assessment of antibodies associated with inflammatory rheumatologic diseases in patients with a history of CWP and fatigue in the absence of other features such as joint swelling, typical rashes or organ involvement [62]. If no other diseases which require imaging studies for diagnosis are suspected on clinical grounds, X-rays or other diagnostic imaging studies are not recommended. A Norwegian longitudinal study in primary care demonstrated a low diagnostic value of imaging studies in patients with CWP [63].

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