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**Antibodies to citrullinated vimentin and mutated citrullinated vimentin (MCV):
**Antibodies to citrullinated vimentin and mutated citrullinated vimentin (MCV):
***It has specificity of about 90.3–98%, with sensitivity of 69.5–82%
***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:'''<ref name="pmid20872595">{{cite journal |vauthors=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 |title=2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative |journal=Arthritis Rheum. |volume=62 |issue=9 |pages=2569–81 |date=September 2010 |pmid=20872595 |doi=10.1002/art.27584 |url=}}</ref>


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 
{| class="wikitable"
! colspan="4" |The 2010 American College of Rheumatology classification criteria for rheumatoid arthritis.
|-
|'''Domains'''
|'''Description'''
|'''Number'''
|'''Score'''
|-
| rowspan="5" |Joint Involvement
| rowspan="3" |Median-large joint<sup>*</sup>
|
|
|-
|2-10
|1
|-
|1-3
|2
|-
| rowspan="2" |Small joints<sup>@</sup>
|4-10
|3
|-
|>10~
|5
|-
| rowspan="3" |Serology
|No positive for either RF or anti-CCP
|
|0
|-
|At least one of these test positive at the high titer
|
|2
|-
|At least one of these test positive at low titer
|
|3
|-
|Duration of synovitis
| +/> six weeks
|
|1
|-
| rowspan="2" |Acute phase reactants
|Neither CRP or ESR is abnormal
|
|0
|-
|Abnormal CRP or ESR
|
|1
|-
| colspan="4" |
* Distal interphalangeal,1st carpometacarpal and 1st tarsometatarsal joints are excluded from the assessment.
<nowiki>*</nowiki>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 joint joins as well as other such as temporomandibular, acromioclavicular, sternoclavicular
|}


==References==
==References==

Revision as of 14:28, 10 April 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2]

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][7]
      • 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:[8]

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 the 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
  • Distal interphalangeal,1st carpometacarpal and 1st tarsometatarsal joints are excluded from the assessment.

*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 joint joins as well as other such as temporomandibular, acromioclavicular, sternoclavicular

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.
  7. ↑ Schellekens GA, Visser H, de Jong BA, van den Hoogen FH, Hazes JM, Breedveld FC, van Venrooij WJ (January 2000). "The diagnostic properties of rheumatoid arthritis antibodies recognizing a cyclic citrullinated peptide". Arthritis Rheum. 43 (1): 155–63. doi:10.1002/1529-0131(200001)43:1<155::AID-ANR20>3.0.CO;2-3. PMID 10643712.
  8. ↑ 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.

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