From the Guidelines
For autoimmune disease evaluation, I recommend a comprehensive panel including complete blood count (CBC), comprehensive metabolic panel (CMP), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) as baseline inflammatory markers, as well as specific autoantibody tests such as antinuclear antibody (ANA) and rheumatoid factor (RF) 1.
Key Laboratory Tests
The following laboratory tests are essential for evaluating autoimmune diseases:
- Complete blood count (CBC) with differential
- Comprehensive metabolic panel (CMP)
- Erythrocyte sedimentation rate (ESR)
- C-reactive protein (CRP)
- Quantitative immunoglobulin levels
- Serologies for HIV and hepatitis B and C
- Antinuclear antibody (ANA) and rheumatoid factor (RF) tests
Additional Targeted Tests
Additional tests may be necessary based on suspected conditions, such as:
- Anti-double stranded DNA and complement levels (C3, C4) for lupus 1
- Anti-thyroid peroxidase and anti-thyroglobulin for autoimmune thyroid disease
- Tissue transglutaminase antibodies for celiac disease
Interpretation of Results
Testing should be interpreted in the context of clinical symptoms, as some autoantibodies can be present in healthy individuals or overlap between different conditions 1. The results guide treatment decisions and provide baseline values to monitor disease activity and treatment response over time.
Recent Recommendations
Recent studies have emphasized the importance of standardization of autoantibody assays, including antinuclear antibodies (ANA) and anti-dsDNA, to ensure accurate diagnosis and monitoring of autoimmune diseases 1.
From the Research
Laboratory Tests for Autoimmune Diseases
The following laboratory tests are recommended for evaluating autoimmune diseases:
- Complete blood count with differential 2
- Comprehensive metabolic panel 2
- Measurement of inflammatory markers, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) 2, 3, 4
- Autoantibody tests, including anti-cyclic citrullinated peptide (CCP) antibodies and rheumatoid factor (RF) 2, 3
- Flow cytometry 2
Diagnostic Utility of Laboratory Tests
The diagnostic utility of laboratory tests varies depending on the specific autoimmune disease:
- Anti-CCP antibodies have better diagnostic performance than MMP-3, RF, CRP, and ESR in patients with erosive rheumatoid arthritis 3
- CRP is a better indicator of inflammation than ESR, and is more sensitive and responsive to changes in the clinical situation 4
- ESR has value in detecting low-grade bone infection and monitoring some patients with systemic lupus erythematosus 4
Organ-Specific Immunologic Diseases
Immunologic laboratory testing is used to evaluate organ-specific immunologic diseases, including: