From the Guidelines
A comprehensive autoimmune workup for inflammatory arthritis should begin with a complete blood count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) to assess inflammation levels, as recommended by the most recent guidelines 1. When evaluating a patient with inflammatory arthritis, it is essential to consider the latest recommendations from the European League Against Rheumatism (EULAR) 1. The initial workup should include specific autoantibody testing, such as rheumatoid factor (RF), anti-cyclic citrullinated peptide antibodies (anti-CCP), and antinuclear antibodies (ANA). If ANA is positive, further testing for specific antibodies like anti-dsDNA, anti-Sm, anti-Ro/SSA, and anti-La/SSB may be warranted. Additional tests should include:
- Complement levels (C3, C4)
- HLA-B27 (especially if spondyloarthropathy is suspected)
- Uric acid levels to rule out gout Imaging studies are also crucial, starting with plain radiographs of affected joints to assess for erosions or joint space narrowing, followed by ultrasound or MRI for more detailed evaluation of synovitis and early erosive changes. The main goal of the autoimmune workup is to distinguish between different types of inflammatory arthritis, such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and systemic lupus erythematosus, and guide appropriate treatment strategies based on the specific diagnosis, with the ultimate goal of achieving clinical remission and improving patient outcomes, as emphasized by the EULAR guidelines 1.
From the Research
Autoimmune Workup for Inflammatory Arthritis
- The diagnosis of rheumatoid arthritis (RA) should be suspected in patients who present with joint inflammation, especially those who have polyarthritis, as stated in 2 and 3.
- Useful diagnostic tests for RA include:
- The combination of RF and anti-CCP antibody can increase the accuracy of RA diagnosis, with a sensitivity of 90.2%, specificity of 83.3%, and accuracy of 89.5% as found in 4.
- Other factors that may impact the diagnosis and judgment of disease activity in RA patients include serum lipids, as studied in 5, which found that the concentrations of HDLC, TG, and LDLC were associated with the concentration of anti-CCP, RF, CRP, and ESR in RA patients.
- Early diagnosis and treatment of RA are crucial to achieve better outcomes, as emphasized in 3 and 6.
- The goal of therapy is to initiate early medical treatment to achieve disease remission or the lowest disease activity possible, with methotrexate typically being the first-line agent for RA, as stated in 2 and 3.