From the Guidelines
A comprehensive autoimmune workup should begin with a thorough laboratory evaluation, including a complete blood count with differential, erythrocyte sedimentation rate, C-reactive protein, and quantitative immunoglobulin levels, as well as serologies for HIV and hepatitis B and C, and testing for antinuclear antibodies and rheumatoid factor. This approach is supported by the most recent evidence, which emphasizes the importance of a comprehensive initial evaluation to guide further testing and management 1.
Key Components of the Workup
- A complete blood count with differential to assess for cytopenias or abnormal peripheral blood cells
- Erythrocyte sedimentation rate and C-reactive protein to evaluate for inflammation
- Quantitative immunoglobulin levels to assess for immune system dysfunction
- Serologies for HIV and hepatitis B and C to exclude these as associated diagnoses
- Testing for antinuclear antibodies and rheumatoid factor to screen for systemic lupus erythematosus or idiopathic juvenile arthritis
Additional Testing
- Antinuclear antibody (ANA) testing should be used as a screening tool, followed by more specific antibody tests such as anti-double-stranded DNA, anti-Smith, anti-Ro/SSA, anti-La/SSB, rheumatoid factor, and anti-cyclic citrullinated peptide antibodies 1.
- Complete blood count, comprehensive metabolic panel, erythrocyte sedimentation rate, and C-reactive protein should be included to assess for inflammation and organ involvement.
- Complement levels (C3, C4) can help evaluate immune complex diseases.
- For suspected specific conditions, order targeted tests like anti-transglutaminase antibodies for celiac disease or anti-thyroid peroxidase antibodies for autoimmune thyroid disease.
Importance of Clinical Context
The pattern of antibody positivity, combined with clinical findings, helps establish a diagnosis and guide treatment decisions. Regular monitoring of these markers can also help track disease activity and treatment response over time. The choice of tests should be guided by the patient's specific symptoms and clinical presentation, and should be interpreted in the context of the overall clinical picture.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Laboratory Evaluation
The laboratory evaluation of a suspected autoimmune illness is crucial in confirming a diagnosis, estimating disease severity, and assessing prognosis 2. The components of the laboratory examination include:
- A complete blood count with differential
- A comprehensive metabolic panel
- Measurement of inflammatory markers and autoantibodies
- Flow cytometry
Clinical Presentation and Diagnosis
Autoimmune disorders are a category of diseases in which the immune system attacks healthy cells, and clinical presentation and diagnosis are disease-specific 3. The diagnosis often corresponds with the degree of inflammation and the systems involved.
Management of Autoimmune Diseases
The primary goal of treatment is to decrease inflammation, minimize symptoms, and lessen the potential for relapse 3. Management of autoimmune diseases in the ICU is complex and requires prompt disease identification, immunosuppressive treatment initiation, and life-sustaining therapies, as well as multi-disciplinary involvement 4.
Infection Risk and Prevention
The treatment of autoimmune diseases involves the use of immunosuppressive or immunomodulatory therapies, which is associated with an increased risk of infection 5. The prevention strategy and clinical management need to be individually tailored, taking into account several key factors, including:
- Characterization of the disease that prompts the immunosuppression
- Understanding of the mechanism of action of the immunosuppressive drug
- Knowledge of previous infections
- Recognition of risk factors
- Laboratory test results
- Vaccine administration
- Monitoring of clinical signs and symptoms
- Patient education
Emerging Therapies
Bispecific antibodies (bsAbs) have recently been developed for a range of autoimmune diseases, including rheumatoid arthritis, systemic lupus erythematosus, and psoriasis, and are being tested in clinical trials 6. These bsAbs mainly target the depletion of T or B cells, the inhibition of T cell differentiation or activation, or the neutralization of proinflammatory cytokines.