Screenings if you have rheumatoid arthritis or lupus

The yearly rheumatoid arthritis review

NICE says all adults with RA, including those whose disease is under control, should be offered an annual review to: (NICE NG100)

• check for other conditions, such as high blood pressure, ischaemic heart disease, osteoporosis and depression
• ask about symptoms that suggest complications, such as vasculitis or disease of the neck bones, lungs or eyes
• measure disease activity and how well you can do daily tasks

See blood pressure readings: what they mean and depression screening: what to expect.

Heart risk checks

EULAR's 2022 recommendations for lupus and other rheumatic diseases stress regular screening for heart risk factors that can be changed, and recommend general risk calculators because no tool built for rheumatic diseases has been validated. (EULAR, 2022) NICE says to use the QRISK3 tool to estimate 10-year heart and stroke risk for people aged 25 to 84 without heart disease. For people with lupus it says to use QRISK3 rather than QRISK2, because QRISK2 does not count lupus and may underestimate risk. It also says risk tools may underestimate risk in people with autoimmune and other systemic inflammatory disorders. (NICE NG238) The usual cholesterol schedule is on cholesterol test by age, and the full list of heart checks is on heart screenings by age.

Bone and fracture risk

NICE's 2026 osteoporosis guideline says to consider a fracture risk assessment for everyone aged 50 to 74, and women under 65 after menopause, who have a risk factor. Its list of risk factors includes rheumatoid arthritis and other inflammatory joint conditions such as systemic lupus erythematosus. It says to assess fracture risk in everyone aged 50 and over, and women after menopause, with current or frequent use of systemic glucocorticoids (for example, 5 mg or more of prednisolone a day for over 3 months). (NICE NG259) The American College of Rheumatology strongly recommends that adults starting or continuing glucocorticoids at 2.5 mg a day or more for over 3 months have a fracture risk assessment as soon as possible, with a bone density scan, a spine image and, from age 40, the FRAX tool. (ACR, 2022) See bone density test: how often and DEXA scan: what to expect.

Cervical screening

A 2025 review of guidelines for cervical screening in people with weak immune systems found a higher risk of HPV, cervical cell changes and cervical cancer in people with lupus, whether or not they take immunosuppressants. It recommends following the CDC cervical screening schedule for people with HIV for: (JLGTD, 2025)

• everyone with lupus, on immunosuppressants or not
• people with RA who take immunosuppressants

For people with RA who do not take immunosuppressants, it says the evidence is mixed, so the usual schedule applies, with the option to decide on more screening together with a doctor. The schedule it reprints for people with HIV starts at age 21, with a Pap test at baseline and every 12 months, moving to every 3 years after 3 normal results in a row. (JLGTD, 2025) See Pap and HPV test results and Pap smear: what to expect.

Other cancer screening

EULAR recommends that women with lupus have cancer screening in the same way as the general population. It says they are not at higher risk of breast, ovarian or endometrial cancer, and should follow the usual screening for these cancers. (EULAR, 2017) The usual schedule is on cancer screenings by age.

Eye checks with long-term hydroxychloroquine

EULAR's heart risk recommendations mention hydroxychloroquine as a medicine used in lupus. (EULAR, 2022) The American Academy of Ophthalmology (AAO) says damage to the retina from it is not reversible, and that high dose and long use are the biggest risks. (AAO, 2016) Eye bodies set a screening schedule for people who take it:

• The AAO advises a baseline eye exam, then yearly screening starting after 5 years for people on usual doses without major risk factors. (AAO, 2016)
• The Royal College of Ophthalmologists in the UK advises yearly monitoring after 5 years of use, starting after 1 year when there are added risk factors such as kidney problems, and no longer advises a baseline test. (RCOphth, 2020)

Both use retinal imaging (optical coherence tomography), and the AAO also uses visual field tests. (AAO, 2016) (RCOphth, 2020) NICE NG100 lists the eyes among the areas to ask about at the yearly RA review. (NICE NG100) See eye exams by age and eye exam: what to expect.

Urine and kidney checks in lupus

The NHS says people with lupus are advised to have regular urine tests to check for kidney problems. (NHS, lupus) MedlinePlus lists serum creatinine and a urinalysis among the tests used to diagnose lupus, and kidney function blood tests among other tests. (MedlinePlus, SLE) See urinalysis results and kidney test results.

When to contact a provider

Where they differ:

• Cervical screening in lupus. EULAR (2017) suggested a yearly Pap test for people who are heavily immunosuppressed and the local screening program for people at low risk, (EULAR, 2017) while the 2025 review recommends the more frequent schedule for everyone with lupus, on immunosuppressants or not. (JLGTD, 2025)
• Cervical cancer risk in lupus. EULAR said women with lupus have a higher risk of cervical cell changes but not of cervical cancer, (EULAR, 2017) while the 2025 review cites newer studies showing a higher risk of cervical cancer as well. (JLGTD, 2025)
• A baseline eye exam. The AAO advises one when hydroxychloroquine is started; (AAO, 2016) the Royal College of Ophthalmologists no longer does. (RCOphth, 2020)
• Glucocorticoid level for bone checks. NICE's example is 5 mg or more of prednisolone a day for over 3 months; (NICE NG259) the ACR guideline starts at 2.5 mg a day for over 3 months. (ACR, 2022)

Your doctor decides what your result means for you.

Questions people ask

What is checked at the yearly rheumatoid arthritis review?

NICE says all adults with RA should be offered an annual review, which includes checking for conditions such as high blood pressure, ischaemic heart disease, osteoporosis and depression, and asking about symptoms that suggest problems in the neck, lungs or eyes. (NICE NG100)

Does lupus change how heart risk is worked out?

NICE says to use the QRISK3 tool for people with systemic lupus erythematosus, because the older QRISK2 tool does not take lupus into account and may underestimate 10-year risk. It also says risk tools may underestimate risk in people with autoimmune and other inflammatory disorders. (NICE NG238)

Do people with lupus need more frequent cervical screening?

A 2025 review of cervical screening guidelines for people with weak immune systems recommends following the CDC screening schedule for people with HIV for everyone with SLE, whether or not they take immunosuppressants. EULAR suggested a yearly Pap test for people who are heavily immunosuppressed and the local screening program for people at low risk. (JLGTD, 2025) (EULAR, 2017)

Is a bone density scan part of rheumatoid arthritis care?

NICE lists rheumatoid arthritis and other inflammatory joint conditions such as lupus among the risk factors for which a fracture risk assessment should be considered from age 50 to 74, and in women under 65 after menopause. NICE NG100 also lists osteoporosis among the conditions to check for at the yearly RA review. (NICE NG259) (NICE NG100)

Are other cancer screenings different with lupus?

EULAR says women with SLE are not at higher risk of breast, ovarian or endometrial cancer than the general population and should follow the usual population screening for these cancers. (EULAR, 2017)

Related

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• Bone density test: how often
• Cholesterol test by age
• Blood pressure readings: what they mean
• Heart screenings by age
• Eye exams by age
• Pap and HPV test results
• Screenings if you have IBD
• Screenings by age and gender
• Questions to ask your doctor