Uncertainty about diagnosis

Where there is uncertainty about the diagnosis, other investigations should be considered. This might include an up-to-date set of baseline blood tests to check for other causes, such as a:

• Full blood count.
• Renal profile.
• Liver function.
• Thyroid function.
• HbA1c.
• Bone profile.
• B12, folate and ferritin levels.
• Coeliac screen if digestive symptoms present.
• Vitamin D level.
• Protein electrophoresis or blood film if clinically indicated.
• Rheumatoid factor, anti-CCP, uric acid and inflammatory markers if clinically indicated.

Clinical acumen is required and where there is suspicion for other conditions, or rarer conditions, more specific tests may be needed. If in doubt, seek specialist input.

If red flags are present consider urgent referral or admission. For information on red flags see NICE CKS guidance.