Rheumatoid arthritis laboratory tests: Difference between revisions

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**Renal function test
**Renal function test
**Liver function test
**Liver function test
**Autoantibodies
**Antibodies
***[[Rheumatoid factor]]-Rheumatoid factor is
***[[Rheumatoid factor]]
===Blood tests===
****Rheumatoid factor is an autoantibody, that can be IgM, IgG or IgA
:
****According to the classification criteria for RA published by the American College of Rheumatology, it recognizes domains CH2 and CH3 of the Fc segment of human IgG
**When RA is being clinically suspected, [[immunology|immunological]] studies are required, such as [[rheumatoid factor]] (RF, a specific [[antibody]]).<ref>{{cite web | title=Rheumatoid Factor | url=http://www.labtestsonline.org/understanding/analytes/rheumatoid/test.html | work=Lab Tests Online | publisher=American Association for Clinical Chemistry | date=September 30, 2006 | accessdate=2006-10-28}}</ref>
**** It has mean specificity of 79%, with sensitivity of about 60%<ref name="pmid24024009">{{cite journal |vauthors=Heidari B |title=Rheumatoid Arthritis: Early diagnosis and treatment outcomes |journal=Caspian J Intern Med |volume=2 |issue=1 |pages=161–70 |date=2011 |pmid=24024009 |pmc=3766928 |doi= |url=}}</ref><ref name="pmid15103252">{{cite journal |vauthors=Dörner T, Egerer K, Feist E, Burmester GR |title=Rheumatoid factor revisited |journal=Curr Opin Rheumatol |volume=16 |issue=3 |pages=246–53 |date=May 2004 |pmid=15103252 |doi= |url=}}</ref>
**A negative RF does not rule out RA; rather, the arthritis is called ''[[seronegative]]''
***Antibodies to cyclic citrullinated peptides (anti-CCP antibodies):<ref name="pmid12607587">{{cite journal |vauthors=van Venrooij WJ, Hazes JM, Visser H |title=Anticitrullinated protein/peptide antibody and its role in the diagnosis and prognosis of early rheumatoid arthritis |journal=Neth J Med |volume=60 |issue=10 |pages=383–8 |date=November 2002 |pmid=12607587 |doi= |url=}}</ref>
**During the first year of illness, rheumatoid factor is frequently negative. 80% of patients eventually convert to seropositive status. RF is also seen in other illnesses, like [[Sjögren's syndrome]], and in approximately 10% of the healthy population, therefore the test is not very specific.
****It has specificity of about 81-100%, with sensitivity of 39–94%
*[[Anti-citrullinated protein]]:
***Antibodies to citrullinated vimentin and mutated citrullinated vimentin (MCV):
**Because of this low [[Specificity (tests)|specificity]], a new serological test has been developed in recent years, which tests for the presence of so called anti-citrullinated protein antibodies (ACPA).
****It has specificity of about 90.3–98%, with sensitivity of 69.5–82%
**Like RF, this test can detect approximately 80% of all RA patients, but is rarely positive in non-RA patients, giving it a specificity of around 98%. In addition, ACP antibodies can be often detected in early stages of the disease, or even before disease onset. Currently, the most common test for ACP antibodies is the anti-CCP (cyclic citrullinated peptide) test.<ref>{{cite web | title=CCP (Cyclic Citrullinated Peptide antibody) | url=http://www.labtestsonline.org/understanding/analytes/ccp/test.html | work=Lab Tests Online | publisher=American Association for Clinical Chemistry | date=January 15, 2005 | accessdate=2006-10-28}}</ref>
*[[ESR]] and [[CRP]]:
**Also, several other [[blood test]]s are usually done to allow for other causes of arthritis, such as [[lupus erythematosus]]. The [[erythrocyte sedimentation rate]] (ESR), [[C-reactive protein]],<!----><ref>{{cite web | title=C-Reactive Protein|url=http://www.labtestsonline.org/understanding/analytes/crp/test.html| work=Lab Tests Online | publisher=American Association for Clinical Chemistry | date=September 3, 2004 | accessdate=2006-10-28}}</ref> [[full blood count]], [[renal function]], [[liver enzyme]]s and other immunological tests (e.g. [[antinuclear antibody]]/ANA)<!----><ref>{{cite web | title=ANA (Antinuclear Antibody) | url=http://www.labtestsonline.org/understanding/analytes/ana/test.html | work=Lab Tests Online | publisher=American Association for Clinical Chemistry | date=December 13, 2004 | accessdate=2006-10-28}}</ref> are all performed at this stage. [[Ferritin]] can reveal [[hemochromatosis]], which can mimic RA.


==References==
==References==

Revision as of 16:18, 4 April 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Laboratory Findings

  • Following tests are used to make the diagnosis of rheumatoid arthritis:[1][2]
    • Complete blood count with differentials
    • Acute phase reactant are used to measure disease progression:[3]
      • Erythrocyte sedimentation rate
      • C-reactive protein: CRP gives an idea about the radiological progression and mean CRP correlates with articular index.
    • Renal function test
    • Liver function test
    • Antibodies
      • Rheumatoid factor
        • Rheumatoid factor is an autoantibody, that can be IgM, IgG or IgA
        • According to the classification criteria for RA published by the American College of Rheumatology, it recognizes domains CH2 and CH3 of the Fc segment of human IgG
        • It has mean specificity of 79%, with sensitivity of about 60%[4][5]
      • Antibodies to cyclic citrullinated peptides (anti-CCP antibodies):[6]
        • It has specificity of about 81-100%, with sensitivity of 39–94%
      • Antibodies to citrullinated vimentin and mutated citrullinated vimentin (MCV):
        • It has specificity of about 90.3–98%, with sensitivity of 69.5–82%

References

  1. ↑ Bayliss CE, Dawkins RL, Cullity G, Davis RE, Houliston JB (October 1975). "Laboratory diagnosis of rheumatoid arthritis. Prospective study of 85 patients". Ann. Rheum. Dis. 34 (5): 395–402. PMC 1006439. PMID 769705.
  2. ↑ Wasserman AM (December 2011). "Diagnosis and management of rheumatoid arthritis". Am Fam Physician. 84 (11): 1245–52. PMID 22150658.
  3. ↑ van Leeuwen MA, van Rijswijk MH, van der Heijde DM, Te Meerman GJ, van Riel PL, Houtman PM, van De Putte LB, Limburg PC (June 1993). "The acute-phase response in relation to radiographic progression in early rheumatoid arthritis: a prospective study during the first three years of the disease". Br. J. Rheumatol. 32 Suppl 3: 9–13. PMID 8508266.
  4. ↑ Heidari B (2011). "Rheumatoid Arthritis: Early diagnosis and treatment outcomes". Caspian J Intern Med. 2 (1): 161–70. PMC 3766928. PMID 24024009.
  5. ↑ Dörner T, Egerer K, Feist E, Burmester GR (May 2004). "Rheumatoid factor revisited". Curr Opin Rheumatol. 16 (3): 246–53. PMID 15103252.
  6. ↑ van Venrooij WJ, Hazes JM, Visser H (November 2002). "Anticitrullinated protein/peptide antibody and its role in the diagnosis and prognosis of early rheumatoid arthritis". Neth J Med. 60 (10): 383–8. PMID 12607587.

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