Rheumatoid arthritis could be a chronic inflammatory disorder that may affect over just your joints. In some people, the condition can damage a vast variety of body systems, including the skin, eyes, lungs, heart and blood vessels. An autoimmune disorder, rheumatoid arthritis occurs when your immune system falsely attacks your own body’s tissues.
Despite of the wear-and-tear damage of osteoarthritis, rheumatoid arthritis affects the layers of your joints, causing a painful swelling that can eventually lead to bone erosion and joint deformity.
The inflammation related to rheumatoid arthritis is what can damage other parts of the body as well. While new kinds of medications have improved treatment options dramatically, severe rheumatoid arthritis can still cause physical impairment.
Panel test:
• Antinuclear antibody (ANA) – Commonly found in the blood of people who have lupus, ANAs (abnormal antibodies directed against the cells’ nuclei) can also suggest the presence of polymyositis, scleroderma, Sjogren’s syndrome, mixed connective tissue disease or rheumatoid arthritis. Tests to detect specific subsets of these antibodies can be used to confirm the diagnosis of a particular disease or form of arthritis.
• Rheumatoid factor (RF) –RF is an antibody against the gamma globulin, and it is commonly positive in people with rheumatoid arthritis.
• Anti-cyclic citrullinated peptide (anti-CCP) — Also named anti-citrullinated protein antibodies (ACPA), this test (like the test for rheumatoid factor) looks for the presence of a specific autoantibody that’s present in approximately 60-80 percent of individuals with RA. While most patients with anti-CCP antibodies are positive for RF, the RF antibody can detect in patients with many other situation, including an infection. Anti-CCP is more specific for RA and is becoming the favored test.
• 14.3.3 eta Protein– The 14-3-3η protein be revealed to contribute to the pathologic process of joint erosion and, as such, is an appearing biomarker of joint damage in rheumatoid arthritis (RA) and psoriatic arthritis. Concentrations are significantly higher in people with active joint disease than in those with inactive RA or psoriasis without arthritis. Measurement of 14-3-3η complements RF and CCP antibody tests may improve diagnostic sensitivity.
• RF isotypes
Compounding of RF IgA and CCP may predict radiological damage in RA
When screening for RA, IgM-RF and CCP assays are preferred to other RF isotypes
• Uric acid – By checking the amount of uric acid in the blood, this test can help doctors diagnose gout, a condition that happens when excess uric acid crystallizes and forms deposits in the joints and other tissues, causing inflammation and serous pain.
• HLA tissue typing – Detection of certain genetic markers, can often confirm a diagnosis of ankylosing spondylitis (a disease involving inflammation of the spine and sacroiliac joint) or reactive arthritis (a disease involving inflammation of the urethra, eyes and joints). The genetic marker HLA-B27 is mostly always present in people with either of these diseases.
• CBC and Erythrocyte sedimentation rate There are many conditions that can cause an elevated ESR, including an infection or anemia.
• C-reactive protein that increases in the presence of inflammation.
• Joint fluid tests – like drawing blood, the doctor inserts a needle into a joint space and pull out the fluid. An examination of the fluid may reveal uric acid crystals, confirming a diagnosis of gout; Bacteria cultured from joint fluid can indicate that the joint inflammation is caused by an infection.
Algorithm
References
1. 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. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum. 2010; 62(9): 2569-81. PubMed
2. Choosing Wisely. An initiative of the ABIM Foundation. [Accessed: Apr 2019]
3. van der Heijde D, van Mil AH, Aletaha D, Bingham CO, Burmester GR, Dougados M, Emery P, Felson D, Knevel R, Kvien TK, Landewé RB, Lukas C, McInnes I, Silman AJ, Smolen JS, Stanislawska-Biernat E, Zink A, Combe B. EULAR definition of erosive disease in light of the 2010 ACR/EULAR rheumatoid arthritis classification criteria Ann Rheum Dis. 2013; 72(4): 479-81. PubMed
