Rheumatoid arthritis laboratory tests
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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
- 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%
The 2010 American College of Rheumatology classification criteria for rheumatoid arthritis:[7]
The 2010 new criteria rates on a scale from 0-10 points are assigned in four separate domains of signs and symptoms:
1) Joint involvement
2) Serology
3) Duration of symptoms
4) Acute phase reactants
Patients are diagnosed with RA if they score 6 or more points according to the following criteria
| The 2010 American College of Rheumatology classification criteria for rheumatoid arthritis. | |||
|---|---|---|---|
| Domains | Description | Number | Score |
| Joint Involvement | Median-large joint* | ||
| 2-10 | 1 | ||
| 1-3 | 2 | ||
| Small joints@ | 4-10 | 3 | |
| >10~ | 5 | ||
| Serology | No positive for either RF or anti-CCP | 0 | |
| At least one of these test positive at high titer | 2 | ||
| At least one of these test positive at low titer | 3 | ||
| Duration of synovitis | +/> six weeks | 1 | |
| Acute phase reactants | Neither CRP or ESR is abnormal | 0 | |
| Abnormal CRP or ESR | 1 | ||
*Shoulder, elbow, knee, ankle @ Small joints refer to metacarpophalangeal, proximal interphalangeal, second through 5th metatarsophalangeal, thumb interphalangeal and wrist joints ~ In this category, at least one of the involved joints must be a small joint; the other joints can include any combination of large additional small jointjoins as well as other such as temporomaibular, acromioclavicular, sternoclavicular | |||
References
- ↑ 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.
- ↑ Wasserman AM (December 2011). "Diagnosis and management of rheumatoid arthritis". Am Fam Physician. 84 (11): 1245–52. PMID 22150658.
- ↑ 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.
- ↑ Heidari B (2011). "Rheumatoid Arthritis: Early diagnosis and treatment outcomes". Caspian J Intern Med. 2 (1): 161–70. PMC 3766928. PMID 24024009.
- ↑ Dörner T, Egerer K, Feist E, Burmester GR (May 2004). "Rheumatoid factor revisited". Curr Opin Rheumatol. 16 (3): 246–53. PMID 15103252.
- ↑ 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.
- ↑ Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO, Birnbaum NS, Burmester GR, Bykerk VP, Cohen MD, Combe B, Costenbader KH, Dougados M, Emery P, Ferraccioli G, Hazes JM, Hobbs K, Huizinga TW, Kavanaugh A, Kay J, Kvien TK, Laing T, Mease P, Ménard HA, Moreland LW, Naden RL, Pincus T, Smolen JS, Stanislawska-Biernat E, Symmons D, Tak PP, Upchurch KS, Vencovský J, Wolfe F, Hawker G (September 2010). "2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative". Arthritis Rheum. 62 (9): 2569–81. doi:10.1002/art.27584. PMID 20872595.