RHEUMATOLOGY TESTING

Maureen Sestito, D.O.

PCOM
Internal Medicine Residency
Rheumatology

The medical specialty concerned with

the study, diagnosis and treatment of
disorders of the articular system.
Immunolgy

The science concerned with the various

phenomena of immunity, induced
sensitivity, and allergy.
Medicine
Diabetes, Heart Disease and Rheumatic
Disorders.
RHEUMATOLOGY TESTING
Overview of the general
efficacy of diagnostic
studies.
Serologic Studies
Synovial Fluid
Radiologic Imaging
Rheumatologic Evaluation
All Rheumatologic and Immune related
disorders have criteria for classification
that include both clinical and laboratory
findings.
 Rheumatologic Evaluation
Testing is performed to define the extent
of disease or to detect other organ
systems that may be involved.
 Rheumatologic Evaluation
The laboratory evaluation of patients with
Rheumatic disease is often informative, but
rarely definitive.
 Rheumatologic Evaluation
All Rheumatologic and Immune mediated
disorders fall into a spectrum of criteria
that often overlap.
The lines between diagnosis are often
blurred.
Serologic Testing

ANA
Rheumatoid Factor
Acute Phase Reactants
Autoantibodies
Complement
Anti Nuclear Antibodies
5% of healthy people have positive ANA titres.

The incidence is greater in women.

Highly sensitive but has a low specificity.

Anti Nuclear Antibodies
Patterns

Peripheral
Diffuse
Speckled
Nucleolar
Anti Nuclear Antibodies
Positivity
SLE 95-99%
Sjogrens 75%
RA 15-35%
Systemic Sclerosis 60-90%
Drug Induced Lupus 100%
MCTD 95-99%
Anti Nuclear Antibodies
Monitoring or Prognosis

Raynauds
Juvenile Arthritis with Uveitis
Anti Nuclear Antibodies
Intrinsic Part of the Diagnostic Criteria

Drug Induced SLE

Autoimmune Hepatitis
MCTD
 Anti Nuclear Antibodies
Not Useful

Rheumatoid Arthritis
Multiple Sclerosis
ITP
Thyroid DiseaseDiscoid Lupus
Infectious Diseases
Malignancies
Silicone Breast Implants
Fibromyalgia
Relatives with autoimmune Diseases
Rheumatoid Factor

IgM Antibody to IgG

1-2% of healthy people are positive

Positive RF increases with age

Positive in 75% of people with Rheumatoid Arthritis

 Rheumatoid Factor
Diseases with Positive RF
Subacute Bacterial Endocarditis
Leprosy
Tuberculosis
Syphilis
Lymes Disease
Rubella
CMV
Mononucleosis
Influenza
Sarcoidosis
Periodontal Disease
Mixed Cryoglobulinemia
 ACUTE PHASE REACTANTS
Parallel Chronic Inflammation

Discriminate Inflammatory from Non-inflammatory

 ACUTE PHASE REACTANTS
Elevated In:
Infections
Inflammatory Arthritis
Autoimmune Disorders
Neoplasia
Pregnancy
Advanced Age
 ACUTE PHASE REACTANTS
COAGULATION
Fibrinigen
Prothrombin
TRANSPORT
Haptoglobin
Transferrin
Ceruloplasm
COMPLIMENTS
C3 & c4
Protease Inhibitors
Albumin
Fibronectin
CRP
Amyloid A
 ERYTHROCYTE SEDIMENTATION RATE

ACUTE
Men:
PHASE REACTANTS
Upper limit= age divided by 2

Women:
Upper limit= (age + 10) divided by 2
ACUTE PHASE REACTANTS
ESR/CRP
Elevated
Inflammation
Anemia
Renal Failure
Pregnancy
Decreased
Changes in Red Cell Morphology
Decreased Fibrinogen
Cryglobulinemia
CHF
 ACUTE PHASE REACTANTS
ESR/CRP
ESR Criteria for Diagnosis:
Giant Cell Arteritis
Polymyalgia Rheumatica

Monitoring Disease Activity:

RA
PMR
GCA

Not Useful:
SLE
Spondyloarthropathies
Gout
Septic Arthritis
AUTOANTIBODIES
There is a great deal of overlap among the
diagnostic categories.

Sensitivities and specificities vary

dramatically.

Assay methods and units are not always

standardized.
 COMPLEMENT

20 Biologically active proteins and inhibitors

CH50
The best screening test
Functional assay of the entire pathway
HYPOCOMPLEMENTEMIA

With Immune Complex Without Immune Complex

Formation Formation

SLE Atheromatous Embolization

Idiopathic Membranoproliferative HUS
Glomerulonephritis Septic Shock
Cryoglobulinemia Liver Failure
Vasculitis Malnutrition
Post Strep GN Pancreatitis
Serum Sickness Burns
Malaria
Porphoria
Conclusion