Interpretation of Rheum Tests

Question 1

proportion of patients with positive test who have the disease…. So a negative test will effectively “rule out” disease

Answer 1

sensitivity (SNOUT)

Question 2

proportion of patients with negative test who do not have the disease….. So a positive test will effectively “rule in” a disease.

Answer 2

specificity (SPIN)

Question 3

indirect measurement of serum APR concentrations, particularly fibrinogen. Influenced by the size, shape, and number of RBC’s. Changes relatively slowly

Answer 3

ESR

Question 4

What happens to the ESR with anemia and polycythemia vera?

Answer 4

increased in anemia and decreased in polycythemia

Question 5

Elevated in obesity due to IL-6 secretion by adipose tissue

Answer 5

ESR and CRP

Question 6

“Normal” ESR values

Answer 6

Male <10mm/hr

Question 7

For what two rheumatic conditions is an elevated ESR most helpful?

Answer 7

Polymyalgia Rheumatica and Giant Cell Arteritis

Question 8

Produced in response to inflammation. Enhances complement binding and phagocytosis. Acute increase within 6 hours; peaks at 48 hours

Answer 8

CRP

Question 9

Normal CRP values for adults

Answer 9

adults: normal is less than 1mg/L and abnormal is greater than 10.

Question 10

An AUTO ANTIBODY directed against Fc portion of IgG

Answer 10

Rheumatoid factor

Question 11

Percent of patients with RA who are RF negative early in the disease

Answer 11

30%

Question 12

Normal RF value

Answer 12

<1:80 considered negative

Question 13

correlates with severe articular disease and extra-articular manifestations

Answer 13

RF (rheumatoid factor)

Question 14

Antibody directed against “citrullinated” peptide residues present within inflammatory sites. Mostly associated with RA

Answer 14

Anti-CCP (citrulline antibody, CCP antibodies)

Question 15

Greater specificity than RF, useful when RF is negative

Answer 15

Anti-CCP (citrulline antibody, CCP antibodies)

Question 16

Autoantibodies directed at nuclear antigens (or contents of cell nucleus). Hallmarks of systemic autoimmune disease

Answer 16

Anti-nuclear Antibodies (ANA)

Question 17

Provide further diagnostic and prognostic data concerning pts who have minimal sx’s or who have clinical features of more than 1 autoimmune disease

Answer 17

Anti-nuclear Antibodies (ANA)

Question 18

How many criteria for lupus should be met before ordering an ANA?

Answer 18

3 of the 11

Question 19

Specific for SLE (60-70%). Single stranded DNA nonspecific. May fluctuate with disease activity

Answer 19

Anti-dsDNA

Question 20

Highly specific for SLE (but not sensitive)

Answer 20

Anti-Sm (smith antigen)

Question 21

Associated with CREST, and scleroderma

Answer 21

Anti-centromere antibody (ACA)

Question 22

Associated with diffuse scleroderma

Answer 22

Anti-topoisomerase I (Scl-70)

Question 23

Associated with Sjogren’s. Can be seen in SLE. May be associated with neonatal heart block in babies of mothers with this antibody

Answer 23

Anti-Ro (SS-A) and La (SS-B)

Question 24

Part of criteria for mixed connective tissue disease.

Answer 24

Anti-U1 snRNP

Question 25

Specific for myositis associated with interstitial lung disease and Raynaud’s

Answer 25

Anti-Jo-1 (anti-histidyl-tRNA synthestase)

Question 26

useful for monitoring disease activity in SLE. Low levels indicate activation of complement cascade and consumption of complement

Answer 26

serum complements

Question 27

Group of autoantibodies mainly of the IgG type directed against antigens in the cytoplasm of neutrophil granulocytes and monocytes

Answer 27

Antineutrophil Cytoplasmic Antibodies (ANCA)

Question 28

most strongly associated with vasculitis

Answer 28

ANCA

Question 29

Syndrome associated most with HLA-B27

Answer 29

ankylosing spondylitis

Question 30

Normal Uric acid levels for adults

Answer 30

men: 4-8.5 mg/dL. women: 2.7-7.3 mg/dL

Question 31

What type of antineutrophil cytoplasmic antibody is associated with Churg-Strauss vasculitis

Answer 31

p-ANCA

Question 32

What syndrome is associated with a positive ANA and anti-centromere AB?

Answer 32

CREST

Question 33

What autoimmune disease is associated with eosinophilia, a positive ANA (either anti-Scl or nucleolar), and sometimes a positive RF?

Answer 33

systemic sclerosis (scleroderma)

Question 34

What syndrome is associated with positive anti-Ro (SS-A) or anti-La (SS-B) antibodies?

Answer 34

Sjogren's

Question 35

What syndrome is associated with a low titer of ANA, but presence of nuclear RNP antibodies?

Answer 35

mixed connective tissue disorder

Question 36

What disorder is associated with positive ANA, anti-PM-Scl and increased CPK/aldolas enzymes?

Answer 36

dermatomyositis