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Interpretation of Rheumatological Tests

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Rheumatology for Primary Care Providers
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Abstract

Joint pain is one of the most common presentations to primary care, and the differentiation between inflammatory and mechanical causes can be challenging. Since autoimmune diseases make up a significant proportion of these patients, serologic testing is important in both diagnosis and clinical decision-making. Unfortunately, due to the presence of autoantibodies in a healthy population, these tests are often perceived as confusing. This chapter will focus on the diagnostic interpretation of normal and abnormal rheumatologic values.

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References

  1. Stinton LM, Fritzler MJ. A clinical approach to autoantibody testing in systemic autoimmune rheumatic disorders. Autoimmun Rev. 2007;7(1):77–84.

    CAS  PubMed  Google Scholar 

  2. Goldenberg DL. Guide to laboratory testing in patients with suspected rheumatic disease. September 27, 2017. https://www.practicalpainmanagement.com/resources/diagnostic-tests/guide-laboratory-testing-patients-suspected-rheumatic-disease. Accessed 6th June 2020.

  3. Aringer M, Costenbader K, Daikh D, et al. 2019 European League Against Rheumatism/American College of Rheumatology classification criteria for systemic lupus erythematosus. Arthritis Rheumatol. 2019;71(9):1400–12.

    PubMed  PubMed Central  Google Scholar 

  4. Rees F, Doherty M, Grainge MJ, Lanyon P, Zhang W. The worldwide incidence and prevalence of systemic lupus erythematosus: a systematic review of epidemiological studies. Rheumatology (Oxford). 2017;56(11):1945–61.

    Google Scholar 

  5. Slater CA, Davis RB, Shmerling RH. Antinuclear antibody testing. A study of clinical utility. Arch Intern Med. 1996;156(13):1421–5.

    CAS  PubMed  Google Scholar 

  6. Fernando MM, Isenberg DA. How to monitor SLE in routine clinical practice. Ann Rheum Dis. 2005;64(4):524–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  7. Leuchten N, Hoyer A, Brinks R, et al. Performance of antinuclear antibodies for classifying systemic lupus erythematosus: a systematic literature review and meta-regression of diagnostic data. Arthritis Care Res (Hoboken). 2018;70(3):428–38.

    CAS  Google Scholar 

  8. Tan EM, Feltkamp TE, Smolen JS, et al. Range of antinuclear antibodies in “healthy” individuals. Arthritis Rheum. 1997;40(9):1601–11.

    CAS  PubMed  Google Scholar 

  9. Satoh M, Chan EK, Ho LA, et al. Prevalence and sociodemographic correlates of antinuclear antibodies in the United States. Arthritis Rheum. 2012;64(7):2319–27.

    PubMed  PubMed Central  Google Scholar 

  10. Kavanaugh A, Tomar R, Reveille J, Solomon DH, Homburger HA. Guidelines for clinical use of the antinuclear antibody test and tests for specific autoantibodies to nuclear antigens. American College of Pathologists. Arch Pathol Lab Med. 2000;124(1):71–81.

    CAS  PubMed  Google Scholar 

  11. Yeo AL, Le S, Ong J, et al. Utility of repeated antinuclear antibody tests: a retrospective database study. Lancet Rheumatol. 2020;2(7):E412–7. https://doi.org/10.1016/S2665-9913(20)30084-9.

    Article  Google Scholar 

  12. Ho KT, Reveille JD. The clinical relevance of autoantibodies in scleroderma. Arthritis Res Ther. 2003;5(2):80–93.

    CAS  PubMed  PubMed Central  Google Scholar 

  13. Agmon-Levin N, Damoiseaux J, Kallenberg C, et al. International recommendations for the assessment of autoantibodies to cellular antigens referred to as anti-nuclear antibodies. Ann Rheum Dis. 2014;73(1):17–23.

    CAS  PubMed  Google Scholar 

  14. Benito-Garcia E, Schur PH, Lahita R, American College of Rheumatology Ad Hoc Committee on Immunologic Testing Guidelines. Guidelines for immunologic laboratory testing in the rheumatic diseases: anti-Sm and anti-RNP antibody tests. Arthritis Rheum. 2004;51(6):1030–44.

    CAS  PubMed  Google Scholar 

  15. Petri M, Orbai AM, Alarcón GS, et al. Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum. 2012;64(8):2677–86.

    PubMed  PubMed Central  Google Scholar 

  16. Swaak AJ, Groenwold J, Bronsveld W. Predictive value of complement profiles and anti-dsDNA in systemic lupus erythematosus. Ann Rheum Dis. 1986;45(5):359–66.

    CAS  PubMed  PubMed Central  Google Scholar 

  17. ter Borg EJ, Horst G, Hummel EJ, Limburg PC, Kallenberg CG. Measurement of increases in anti-double-stranded DNA antibody levels as a predictor of disease exacerbation in systemic lupus erythematosus. A long-term, prospective study. Arthritis Rheum. 1990;33(5):634–43.

    PubMed  Google Scholar 

  18. Hahn BH. Antibodies to DNA. N Engl J Med. 1998;338(19):1359–68.

    CAS  PubMed  Google Scholar 

  19. Pan LT, Tin SK, Boey ML, Fong KY. The sensitivity and specificity of autoantibodies to the Sm antigen in the diagnosis of systemic lupus erythematosus. Ann Acad Med Singap. 1998;27(1):21–3.

    CAS  PubMed  Google Scholar 

  20. Hess E. Drug-related lupus. N Engl J Med. 1988;318(22):1460–2.

    CAS  PubMed  Google Scholar 

  21. Haraoui B, Keystone E. Musculoskeletal manifestations and autoimmune diseases related to new biologic agents. Curr Opin Rheumatol. 2006;18(1):96–100.

    PubMed  Google Scholar 

  22. Antonov D, Kazandjieva J, Etugov D, Gospodinov D, Tsankov N. Drug induced lupus erythematosus. Clin Dermatol. 2004;22(2):157–66.

    PubMed  Google Scholar 

  23. Cozzani E, Drosera M, Gasparini G, Parodi A. Serology of lupus erythematosus: correlation between immunopathological features and clinical aspects. Autoimmune Dis. 2014;2014:321359.

    PubMed  PubMed Central  Google Scholar 

  24. Olsen NJ. Drug-induced autoimmunity. Best Pract Res Clin Rheumatol. 2004;18(5):677–88.

    CAS  PubMed  Google Scholar 

  25. Colglazier CL, Sutej PG. Laboratory testing in the rheumatic diseases: a practical review. South Med J. 2005;98(2):185–91.

    PubMed  Google Scholar 

  26. Shiboski SC, Shiboski CH, Criswell L, Baer A, Challacombe S, Lanfranchi H. American College of Rheumatology classification criteria for Sjögren’s syndrome: a data-driven, expert consensus approach in the Sjögren’s International Collaborative Clinical Alliance cohort. Arthritis Care Res (Hoboken). 2012;64(4):475–87.

    CAS  Google Scholar 

  27. Vitali C, Bombardieri S, Jonsson R, et al. Classification criteria for Sjögren’s syndrome: a revised version of the European criteria proposed by the American-European Consensus Group. Ann Rheum Dis. 2002;61(6):554–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  28. Wenzel J, Gerdsen R, Uerlich M, Bauer R, Bieber T, Boehm I. Antibodies targeting extractable nuclear antigens: historical development and current knowledge. Br J Dermatol. 2001;145(6):859–67.

    CAS  PubMed  Google Scholar 

  29. Franceschini F, Cavazzana I. Anti-Ro/SSA and La/SSB antibodies. Autoimmunity. 2005;38(1):55–63.

    CAS  PubMed  Google Scholar 

  30. Yoshimi R, Ueda A, Ozato K, Ishigatsubo Y. Clinical and pathological roles of Ro/SSA autoantibody system. Clin Dev Immunol. 2012;2012:606195.

    PubMed  PubMed Central  Google Scholar 

  31. Brucato A, Frassi M, Franceschini F, et al. Risk of congenital complete heart block in newborns of mothers with anti-Ro/SSA antibodies detected by counterimmunoelectrophoresis: a prospective study of 100 women. Arthritis Rheum. 2001;44(8):1832–5.

    CAS  PubMed  Google Scholar 

  32. Reveille JD, Solomon DH, American College of Rheumatology Ad Hoc Committee of Immunologic Testing Guidelines. Evidence-based guidelines for the use of immunologic tests: anticentromere, Scl-70, and nucleolar antibodies. Arthritis Rheum. 2003;49(3):399–412.

    PubMed  Google Scholar 

  33. Dalakas MC, Hohlfeld R. Polymyositis and dermatomyositis. Lancet. 2003;362(9388):971–82.

    CAS  PubMed  Google Scholar 

  34. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO 3rd, et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis. 2010;69(9):1580–8.

    PubMed  Google Scholar 

  35. Shmerling RH, Delbanco TL. The rheumatoid factor: an analysis of clinical utility. Am J Med. 1991;91(5):528–34.

    CAS  PubMed  Google Scholar 

  36. Aletaha D, Alasti F, Smolen JS. Rheumatoid factor determines structural progression of rheumatoid arthritis dependent and independent of disease activity. Ann Rheum Dis. 2013;72(6):875–80.

    PubMed  Google Scholar 

  37. Nishimura K, Sugiyama D, Kogata Y, et al. Meta-analysis: diagnostic accuracy of anti-cyclic citrullinated peptide antibody and rheumatoid factor for rheumatoid arthritis. Ann Intern Med. 2007;146(11):797–808.

    PubMed  Google Scholar 

  38. Whiting PF, Smidt N, Sterne JA, et al. Systematic review: accuracy of anti-citrullinated peptide antibodies for diagnosing rheumatoid arthritis. Ann Intern Med. 2010;152(7):456–64; W155-66.

    PubMed  Google Scholar 

  39. Rao JK, Weinberger M, Oddone EZ, Allen NB, Landsman P, Feussner JR. The role of antineutrophil cytoplasmic antibody (c-ANCA) testing in the diagnosis of Wegener granulomatosis. A literature review and meta-analysis. Ann Intern Med. 1995;123(12):925–32.

    CAS  PubMed  Google Scholar 

  40. Vassilopoulos D, Hoffman GS. Clinical utility of testing for antineutrophil cytoplasmic antibodies. Clin Diagn Lab Immunol. 1999;6(5):645–51.

    CAS  PubMed  PubMed Central  Google Scholar 

  41. Sablé-Fourtassou R, Cohen P, Mahr A, Pagnoux C, Mouthon L, Jayne D. Antineutrophil cytoplasmic antibodies and the Churg-Strauss syndrome. Ann Intern Med. 2005;143(9):632–8.

    PubMed  Google Scholar 

  42. Dasgupta B, Cimmino MA, Kremers HM, Schmidt WA, Schirmer M, Salvarani C, et al. 2012 provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Arthritis Rheum. 2012;64(4):943–54.

    PubMed  Google Scholar 

  43. Brigden ML. Clinical utility of the erythrocyte sedimentation rate. Am Fam Physician. 1999;60(5):1443–50.

    CAS  PubMed  Google Scholar 

  44. Bray C, Bell LN, Liang H, et al. Erythrocyte sedimentation rate and C-reactive protein measurements and their relevance in clinical medicine. WMJ. 2016;115(6):317–21.

    PubMed  Google Scholar 

  45. Gaitonde S, Samols D, Kushner I. C-reactive protein and systemic lupus erythematosus. Arthritis Rheum. 2008;59(12):1814–20.

    CAS  PubMed  Google Scholar 

  46. Chen B, Li J, He C, Li D, Tong W, Zou Y, Xu W. Role of HLA-B27 in the pathogenesis of ankylosing spondylitis (review). Mol Med Rep. 2017;15(4):1943–51.

    CAS  PubMed  PubMed Central  Google Scholar 

  47. Reveille JD, Hirsch R, Dillon CF, Carroll MD, Weisman MH. The prevalence of HLA-B27 in the US: data from the US National Health and Nutrition Examination Survey, 2009. Arthritis Rheum. 2012;64(5):1407–11.

    PubMed  PubMed Central  Google Scholar 

  48. Sheehan NJ. The ramifications of HLA-B27. J R Soc Med. 2004;97(1):10–4.

    CAS  PubMed  PubMed Central  Google Scholar 

  49. Shmerling RH, Delbanco TL. The rheumatoid factor: an analysis of clinical utility. Am J Med. 1991;91(5):530.

    Google Scholar 

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Correspondence to Yousaf Ali .

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Murray, S., Ali, Y. (2022). Interpretation of Rheumatological Tests. In: Ali, Y. (eds) Rheumatology for Primary Care Providers. Springer, Cham. https://doi.org/10.1007/978-3-030-80699-6_10

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  • DOI: https://doi.org/10.1007/978-3-030-80699-6_10

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  • Publisher Name: Springer, Cham

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