From the Guidelines
Personalized medicine tests for autoimmune and rheumatologic conditions should include autoantibody panels like ANA, anti-CCP, and rheumatoid factor, as well as genetic testing for HLA-B27, to help diagnose and manage specific diseases such as lupus, rheumatoid arthritis, and Sjögren's syndrome. When evaluating patients with undifferentiated peripheral inflammatory arthritis (UPIA), testing for rheumatoid factor (RF) and/or anti-citrullinated protein/peptide antibodies (ACPA) is recommended, as these factors are predictive of RA diagnosis and prognosis 1. Additionally, inflammatory marker tests such as CRP and ESR can help monitor disease activity and treatment response 1. It is also important to consider the clinical context and pre-test probability when interpreting test results, and to use a cut-off point of 1:160 for ANA detection to increase specificity 1. Some newer tests, such as the Vectra DA test and the Avise CTD test, may also be useful in assessing disease activity and differentiating between various connective tissue diseases. Pharmacogenomic testing, such as TPMT testing for azathioprine and MTHFR testing for methotrexate, can help guide medication selection and optimize dosing. These tests should be interpreted by rheumatologists or immunologists who can integrate results with clinical findings, as no single test is definitive for autoimmune conditions.
Key points to consider when using personalized medicine tests for autoimmune and rheumatologic conditions include:
- Using autoantibody panels and genetic testing to diagnose and manage specific diseases
- Considering the clinical context and pre-test probability when interpreting test results
- Using a cut-off point of 1:160 for ANA detection to increase specificity
- Monitoring disease activity and treatment response with inflammatory marker tests
- Using pharmacogenomic testing to guide medication selection and optimize dosing
- Interpreting test results in conjunction with clinical findings by a rheumatologist or immunologist.
It is essential to stay up-to-date with the latest evidence and guidelines, as the field of personalized medicine for autoimmune and rheumatologic conditions is rapidly evolving, with emerging technologies like RNA sequencing and proteomics promising even more personalized approaches to diagnosis and treatment in the future 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Effective Personalized Medicine Tests for Autoimmune or Rheumatologic Disorders
The following tests are used to diagnose and manage autoimmune or rheumatologic disorders:
- Rheumatoid factor test: used to diagnose rheumatoid arthritis (RA) 2, 3, 4, 5
- Anticyclic citrullinated peptide (anti-CCP) antibodies test: used to diagnose RA 2, 4
- Erythrocyte sedimentation rate (ESR) test: used to assess inflammation in RA, polymyalgia rheumatica, and temporal arteritis 2, 3, 4, 5
- C-reactive protein (CRP) test: used to assess inflammation in RA 3, 4, 5
- Antinuclear antibody (ANA) test: used to diagnose systemic lupus erythematosus and other connective tissue diseases 3, 5
- Anti-double-stranded DNA antibodies test: used to diagnose lupus nephritis and monitor disease activity in systemic lupus erythematosus 3
- Anti-Ro (anti-SS-A) and anti-La (anti-SS-B) antibodies test: used to diagnose Sjögren's syndrome and systemic lupus erythematosus 3
- Cytoplasmic antineutrophil cytoplasmic antibody (ANCA) test: used to diagnose Wegener's granulomatosis 3, 5
- Human leukocyte antigen-B27 (HLA-B27) test: used to diagnose ankylosing spondylitis and Reiter's syndrome 3
- Complete Blood Count (CBC) test: used to detect disease activity and prognosis in rheumatic disorders, including systemic lupus erythematosus and rheumatoid arthritis 6
- Neutrophil-to-Lymphocyte Ratio (NLR) test: used to assess disease activity and response to treatment in RA 6
- Mean Platelet Volume (MPV) test: used to determine the prognosis of renal involvement in systemic lupus erythematosus (SLE) 6
- Red cell distribution width (RDW) test: used as an inflammatory biomarker with a prognostic role in rheumatic disorders 6
- Platelet to lymphocyte ratio (PLR) test: used as an inflammatory biomarker with a prognostic role in rheumatic disorders 6
Limitations of Laboratory Tests
Laboratory tests have limitations in diagnosing and managing autoimmune or rheumatologic disorders, including:
- False-negative results: some patients with RA may have negative tests for rheumatoid factor or anti-CCP antibodies, or a normal ESR or CRP 2, 4
- False-positive results: some normal people may have a positive test for rheumatoid factor or anti-CCP antibodies, but do not have RA 4
- Limited specificity and sensitivity: some laboratory tests, such as ESR and CRP, do not have sufficient specificity to appraise disease activity 6