drkbravva
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09.30.05 (2 years ago)
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A,C are TRUE REGARDING ANTI-CCP
B ,D-are-FALSE
Results In ERA, the diagnostic sensitivity of RF and anti-CCP antibodies was 57% and 79% respectively. In LRA, it was 81% and 84% respectively.
Conclusion Anti-CCP antibodies are 20% more sensitivity than RF in the diagnosis of early RA.
When the citrulline antibody is found in a patient's blood, there is a 90-95% likelihood that the patient has rheumatoid arthritis.
Laboratory evaluation
Laboratory abnormalities that occur in rheumatoid arthritis include the presence of rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibody. The RF test measures IgM autoantibodies that are directed against the Fc portion of IgG. Patients who test positive for RF are described as being seropositive. Although about 85% of patients become seropositive at some point, this test alone is neither sufficient nor necessary to make the diagnosis (9).
A patient who has a negative RF test early in the course of disease may ultimately have a positive one, and thus retesting at 6 months may be appropriate. However, once a positive result is identified, serial measurements of RF titer are not helpful in monitoring the course of disease. A positive RF test may also be seen in association with other diseases, such as chronic infections and malignancies (9).
Anti-CCP antibodies may be found in some patients with rheumatoid arthritis and, rarely, in other diseases (9,10). The sensitivity of the anti-CCP antibody test is comparable to that of the IgM RF test, but the specificity is 90% to 96%, making it the most specific evaluation for rheumatoid arthritis (10,11).
Measurement of anti-CCP antibody is not the definitive test for rheumatoid arthritis. However, it does appear to be a useful tool in diagnosis or exclusion of this disease in patients with polyarthritis, and it is becoming more commonly used in clinical practice. Presence of anti-CCP antibody and RF is associated with greater disease severity, suggesting their usefulness as markers of prognosis (12).
Other laboratory abnormalities in rheumatoid arthritis include elevations in test results that are indicative of acute phase reactants, such as increases in the erythrocyte sedimentation rate and C-reactive protein level. These indicators are less specific than RF or anti-CCP antibody, but they may be helpful in distinguishing rheumatoid arthritis from noninflammatory diseases such as osteoarthritis when physical signs are not prominent. Erythrocyte sedimentation rate and C-reactive protein level are also used to monitor therapy; unlike the RF value, these measurements do fluctuate with disease activity.
Anemia of chronic disease is commonly found in rheumatoid arthritis; leukocytosis, thrombocytosis, and hypoalbuminemia are often seen in active disease. Antinuclear antibodies may be detected in about 40% of patients with rheumatoid arthritis (13). Analysis of fluid aspirated from involved joints, although not necessary for diagnosis, demonstrates the leukocytosis typical of inflammatory arthritis.
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