1. Laboratory tests in Rheumatology
Iraj Salehi-Abari MD.,
Internist
Rheumatologist

2. Clinical applications of Lab. Tests:
Screening
Diagnosis
Severity, Activity
Follow up
Complications
Salehi I.

3. Clinical applications of Lab. Tests:
Screening
Diagnosis
Severity, Activity
Follow up
Complications
Salehi I.

4. Clinical applications of Lab. Tests:
Screening
Diagnosis
Severity, Activity
Follow up
Complications
Salehi I.

5. Clinical applications of Lab. Tests:
Screening
Diagnosis
Severity, Activity
Follow up
Complications
Salehi I.

6. Clinical applications of Lab. Tests:
Screening
Diagnosis
Severity, Activity
Follow up
Complications
Salehi I.

7. Clinical applications of Lab. Tests:
Screening
Diagnosis
Severity, Activity
Follow up
Complications
Salehi I.

8. Almost all Hx & Ph.E. is at first
Lab. tests
Almost all Hx & Ph.E. is at first
Hx: until 60%  Dx
Hx + Ph.E.: until 90%  Dx
Hx + Ph.E. + Lab. Data: until 95%  Dx
Salehi I.

9. Almost all Hx & Ph.E. is at first
Lab. tests
Almost all Hx & Ph.E. is at first
Hx: until 60%  Dx
Hx + Ph.E.: until 90%  Dx
Hx + Ph.E. + Lab. Data: until 95%  Dx
Salehi I.

10. Almost all Hx & Ph.E. is at first
Lab. tests
Almost all Hx & Ph.E. is at first
Hx: until 60%  Dx
Hx + Ph.E.: until 90%  Dx
Hx + Ph.E. + Lab. Data: until 95%  Dx
Salehi I.

11. Almost all Hx & Ph.E. is at first
Lab. tests
Almost all Hx & Ph.E. is at first
Hx: until 60%  Dx
Hx + Ph.E.: until 90%  Dx
Hx + Ph.E. + Lab. Data: until 95%  Dx
Salehi I.

12. There is not any definite diagnostic test
Lab. tests
There is not any definite diagnostic test
Positive RF is not equal to Dx of RA
Positive ANA is not equal to Dx of SLE
Positive ANCA is not equal to Dx of WG
Moreover anti-CCP for RA and anti-dsDNA or anti-Sm for SLE are not equal to Dx without compatible clinical findings
Salehi I.

13. There is not any definite diagnostic test
Lab. tests
There is not any definite diagnostic test
Positive RF is not equal to Dx of RA
Positive ANA is not equal to Dx of SLE
Positive ANCA is not equal to Dx of WG
Moreover anti-CCP for RA and anti-dsDNA or anti-Sm for SLE are not equal to Dx without compatible clinical findings
Salehi I.

14. There is not any definite diagnostic test
Lab. tests
There is not any definite diagnostic test
Positive RF is not equal to Dx of RA
Positive ANA is not equal to Dx of SLE
Positive ANCA is not equal to Dx of WG
Moreover anti-CCP for RA and anti-dsDNA or anti-Sm for SLE are not equal to Dx without compatible clinical findings
Salehi I.

15. There is not any definite diagnostic test
Lab. tests
There is not any definite diagnostic test
Positive RF is not equal to Dx of RA
Positive ANA is not equal to Dx of SLE
Positive ANCA is not equal to Dx of WG
Moreover anti-CCP for RA and anti-dsDNA or anti-Sm for SLE are not equal to Dx without compatible clinical findings
Salehi I.

16. There is not any definite diagnostic test
Lab. tests
There is not any definite diagnostic test
Positive RF is not equal to Dx of RA
Positive ANA is not equal to Dx of SLE
Positive ANCA is not equal to Dx of WG
Moreover anti-CCP for RA and anti-dsDNA or anti-Sm for SLE are not equal to Dx without compatible clinical findings
Salehi I.

17. We know that: A negative test never rule out the Dx
Lab. tests
We know that:
A negative test never rule out the Dx
A test may be positive or negative in a disease
A test may be positive in different disease
A test may be positive in normal population
Salehi I.

18. We know that: A negative test never rule out the Dx
Lab. tests
We know that:
A negative test never rule out the Dx
A test may be positive or negative in a disease
A test may be positive in different disease
A test may be positive in normal population
Salehi I.

19. We know that: A negative test never rule out the Dx
Lab. tests
We know that:
A negative test never rule out the Dx
A test may be positive or negative in a disease
A test may be positive in different disease
A test may be positive in normal population
Salehi I.

20. We know that: A negative test never rule out the Dx
Lab. tests
We know that:
A negative test never rule out the Dx
A test may be positive or negative in a disease
A test may be positive in different disease
A test may be positive in normal population
Salehi I.

21. We know that: A negative test never rule out the Dx
Lab. tests
We know that:
A negative test never rule out the Dx
A test may be positive or negative in a disease
A test may be positive in different disease
A test may be positive in normal population
Salehi I.

22. Attention please: With every new test we can not go away from old test
Lab. tests
Attention please:
With every new test we can not go away from old test
We do not have ’’Rheumatologic profile’’ in laboratory tests
Per case, after Hx and Ph.E. we must choose one or more compatible test and step by step, additional tests
Salehi I.

23. Attention please: With every new test we can not go away from old test
Lab. tests
Attention please:
With every new test we can not go away from old test
We do not have ’’Rheumatologic profile’’ in laboratory tests
Per case, after Hx and Ph.E. we must choose one or more compatible test and step by step, additional tests
Salehi I.

24. Attention please: With every new test we can not go away from old test
Lab. tests
Attention please:
With every new test we can not go away from old test
We do not have ’’Rheumatologic profile’’ in laboratory tests
Per case, after Hx and Ph.E. we must choose one or more compatible test and step by step, additional tests
Salehi I.

25. Attention please: With every new test we can not go away from old test
Lab. tests
Attention please:
With every new test we can not go away from old test
We do not have ’’Rheumatologic profile’’ in laboratory tests
Per case, after Hx and Ph.E. we must choose one or more compatible test and step by step, additional tests
Salehi I.

26. Attention please: We have many new tests that:
Lab. tests
Attention please:
We have many new tests that:
Very low sensitive
Nonpractical
Only for research
Expensive
There are many Laboratory centers that:
Nonstandard
Nonreferral
Salehi I.

27. Attention please: We have many new tests that:
Lab. tests
Attention please:
We have many new tests that:
Very low sensitive
Nonpractical
Only for research
Expensive
There are many Laboratory centers that:
Nonstandard
Nonreferral
Salehi I.

28. Attention please: We have many new tests that:
Lab. tests
Attention please:
We have many new tests that:
Very low sensitive
Nonpractical
Only for research
Expensive
There are many Laboratory centers that:
Nonstandard
Nonreferral
Salehi I.

29. A wrong approach to patient
Lab. tests
A wrong approach to patient
For an eighty y/o woman with hands and knees pain
A physicin orders:
ESR, CRP
RF, ANA,
ASO,
Wright, Widal
Anti-CCP, Anti-dsDNA, Anti-Sm
Salehi I.

30. A wrong approach to patient
Lab. tests
A wrong approach to patient
For an eighty y/o woman with hands and knees pain
A physicin orders:
ESR, CRP
RF, ANA,
ASO,
Wright, Widal
Anti-CCP, Anti-dsDNA, Anti-Sm
Salehi I.

31. A wrong approach to patient
Lab. tests
A wrong approach to patient
For an eighty y/o woman with hands and knees pain
A physicin orders:
ESR, CRP
RF, ANA,
ASO,
Wright, Widal
Anti-CCP, Anti-dsDNA, Anti-Sm
Salehi I.

32. The principal Laboratory tests in Rheumatology:
Lab. tests
The principal Laboratory tests in Rheumatology:
CBC, Diff., Plt.
ESR, CRP
BUN/Cr, U/A
Ca/P, Alk. Ph.
LFT: SGOT, SGPT
Salehi I.

33. The principal Laboratory tests in Rheumatology:
Lab. tests
The principal Laboratory tests in Rheumatology:
CBC, Diff., Plt.
ESR, CRP
BUN/Cr, U/A
Ca/P, Alk. Ph.
LFT: SGOT, SGPT
Salehi I.

34. The principal Laboratory tests in Rheumatology:
Lab. tests
The principal Laboratory tests in Rheumatology:
CBC, Diff., Plt.
ESR, CRP
BUN/Cr, U/A
Ca/P, Alk. Ph.
LFT: SGOT, SGPT
Salehi I.

35. The principal Laboratory tests in Rheumatology:
Lab. tests
The principal Laboratory tests in Rheumatology:
CBC, Diff., Plt.
ESR, CRP
BUN/Cr, U/A
Ca/P, Alk. Ph.
LFT: SGOT, SGPT
Salehi I.

36. The principal Laboratory tests in Rheumatology:
Lab. tests
The principal Laboratory tests in Rheumatology:
CBC, Diff., Plt.
ESR, CRP
BUN/Cr, U/A
Ca/P, Alk. Ph.
LFT: SGOT, SGPT
Salehi I.

37. The principal Laboratory tests in Rheumatology:
Lab. tests
The principal Laboratory tests in Rheumatology:
CBC, Diff., Plt.
ESR, CRP
BUN/Cr, U/A
Ca/P, Alk. Ph.
LFT: SGOT, SGPT
Salehi I.

38. Rheumatoid Factor (RF):
Lab. tests
Rheumatoid Factor (RF):
Nonscreening for RA
Nonspecific for RA
Seen in many rheumatic and nonrheumatologic diseases
Seen in normal population:
Young: 5%
Elderly subjects: until 25%
Positive RF nonequal to RA
Salehi I.

39. Rheumatoid Factor (RF):
Lab. tests
Rheumatoid Factor (RF):
Nonscreening for RA
Nonspecific for RA
Seen in many rheumatic and nonrheumatologic diseases
Seen in normal population:
Young: 5%
Elderly subjects: until 25%
Positive RF nonequal to RA
Salehi I.

40. Rheumatoid Factor (RF):
Lab. tests
Rheumatoid Factor (RF):
Nonscreening for RA
Nonspecific for RA
Seen in many rheumatic and nonrheumatologic diseases
Seen in normal population:
Young: 5%
Elderly subjects: until 25%
Positive RF nonequal to RA
Salehi I.

41. Rheumatoid Factor (RF):
Lab. tests
Rheumatoid Factor (RF):
Nonscreening for RA
Nonspecific for RA
Seen in many rheumatic and nonrheumatologic diseases
Seen in normal population:
Young: 5%
Elderly subjects: until 25%
Positive RF nonequal to RA
Salehi I.

42. Rheumatoid Factor (RF):
Lab. tests
Rheumatoid Factor (RF):
Nonscreening for RA
Nonspecific for RA
Seen in many rheumatic and nonrheumatologic diseases
Seen in normal population:
Young: 5%
Elderly subjects: until 25%
Positive RF nonequal to RA
Salehi I.

43. Rheumatoid Factor (RF):
Lab. tests
Rheumatoid Factor (RF):
Nonscreening for RA
Nonspecific for RA
Seen in many rheumatic and nonrheumatologic diseases
Seen in normal population:
Young: 5%
Elderly subjects: until 25%
Positive RF nonequal to RA
Salehi I.

44. Rheumatoid Factor (RF):
Lab. tests
Rheumatoid Factor (RF):
Sensitivity in RA: 26-90%
Negative RF: No rule out RA
Positive predictive value:
For RA: 24%
For any Rheumatic disease: 34%
Salehi I.

45. Rheumatoid Factor (RF):
Lab. tests
Rheumatoid Factor (RF):
Sensitivity in RA: 26-90%
Negative RF: No rule out RA
Positive predictive value:
For RA: 24%
For any Rheumatic disease: 34%
Salehi I.

46. Rheumatoid Factor (RF):
Lab. tests
Rheumatoid Factor (RF):
Sensitivity in RA: 26-90%
Negative RF: No rule out RA
Positive predictive value:
For RA: 24%
For any Rheumatic disease: 34%
Salehi I.

47. Rheumatoid Factor (RF):
Lab. tests
Rheumatoid Factor (RF):
Sensitivity in RA: 26-90%
Negative RF: No rule out RA
Positive predictive value:
For RA: 24%
For any Rheumatic disease: 34%
Salehi I.

48. Rheumatoid Factor (RF):
Lab. tests
Rheumatoid Factor (RF):
Negative predictive value:
For RA: until 89%
For any Rheumatic d.: until 85%
In higher titer:
Positive predictive value: increases
RF titer > 1/640:
Specificity for RA: 99%
Sensitivity for RA: 8%
It has prognostic value in RA
Salehi I.

49. Rheumatoid Factor (RF):
Lab. tests
Rheumatoid Factor (RF):
Negative predictive value:
For RA: until 89%
For any Rheumatic d.: until 85%
In higher titer:
Positive predictive value: increases
RF titer > 1/640:
Specificity for RA: 99%
Sensitivity for RA: 8%
It has prognostic value in RA
Salehi I.

50. Rheumatoid Factor (RF):
Lab. tests
Rheumatoid Factor (RF):
Negative predictive value:
For RA: until 89%
For any Rheumatic d.: until 85%
In higher titer:
Positive predictive value: increases
RF titer > 1/640:
Specificity for RA: 99%
Sensitivity for RA: 8%
It has prognostic value in RA
Salehi I.

51. Rheumatoid Factor (RF):
Lab. tests
Rheumatoid Factor (RF):
Negative predictive value:
For RA: until 89%
For any Rheumatic d.: until 85%
In higher titer:
Positive predictive value: increases
RF titer > 1/640:
Specificity for RA: 99%
Sensitivity for RA: 8%
It has prognostic value in RA
Salehi I.

52. Rheumatoid Factor (RF):
Lab. tests
Rheumatoid Factor (RF):
We recommend RF testing in patients with:
Chronic polyarthralgia
Arthritis:
Polyarthritis
Oligoarthritis
Chronic monoarthritis
Prominent morning stiffness
Sicca symptoms
As prognostic value in RA
Salehi I.

53. Rheumatoid Factor (RF):
Lab. tests
Rheumatoid Factor (RF):
We recommend RF testing in patients with:
Chronic polyarthralgia
Arthritis:
Polyarthritis
Oligoarthritis
Chronic monoarthritis
Prominent morning stiffness
Sicca symptoms
As prognostic value in RA
Salehi I.

54. Rheumatoid Factor (RF):
Lab. tests
Rheumatoid Factor (RF):
We recommend RF testing in patients with:
Chronic polyarthralgia
Arthritis:
Polyarthritis
Oligoarthritis
Chronic monoarthritis
Prominent morning stiffness
Sicca symptoms
As prognostic value in RA
Salehi I.

55. Rheumatoid Factor (RF):
Lab. tests
Rheumatoid Factor (RF):
We recommend RF testing in patients with:
Chronic polyarthralgia
Arthritis:
Polyarthritis
Oligoarthritis
Chronic monoarthritis
Prominent morning stiffness
Sicca symptoms
As prognostic value in RA
Salehi I.

56. Rheumatoid Factor (RF):
Lab. tests
Rheumatoid Factor (RF):
We recommend RF testing in patients with:
Chronic polyarthralgia
Arthritis:
Polyarthritis
Oligoarthritis
Chronic monoarthritis
Prominent morning stiffness
Sicca symptoms
As prognostic value in RA
Salehi I.

57. Rheumatoid Factor (RF):
Lab. tests
Rheumatoid Factor (RF):
We recommend RF testing in patients with:
Chronic polyarthralgia
Arthritis:
Polyarthritis
Oligoarthritis
Chronic monoarthritis
Prominent morning stiffness
Sicca symptoms
As prognostic value in RA
Salehi I.

58. Rheumatoid Factor (RF):
Lab. tests
Rheumatoid Factor (RF):
We recommend RF testing in patients with:
Chronic polyarthralgia
Arthritis:
Polyarthritis
Oligoarthritis
Chronic monoarthritis
Prominent morning stiffness
Sicca symptoms
As prognostic value in RA
Salehi I.

59. Anti-Cyclic Citrullinated Peptide (anti-CCP):
Lab. tests
Anti-Cyclic Citrullinated Peptide (anti-CCP):
In high titers more specific for RA
Occurs in other disease in lower titer:
Active TB
SLE
Sjogren’s syndrome
PM/DM
Scleroderma
Prognostic value > RF
Salehi I.

60. Anti-Cyclic Citrullinated Peptide (anti-CCP):
Lab. tests
Anti-Cyclic Citrullinated Peptide (anti-CCP):
In high titers more specific for RA
Occurs in other disease in lower titer:
Active TB
SLE
Sjogren’s syndrome
PM/DM
Scleroderma
Prognostic value > RF
Salehi I.

61. Anti-Cyclic Citrullinated Peptide (anti-CCP):
Lab. tests
Anti-Cyclic Citrullinated Peptide (anti-CCP):
In high titers more specific for RA
Occurs in other disease in lower titer:
Active TB
SLE
Sjogren’s syndrome
PM/DM
Scleroderma
Prognostic value > RF
Salehi I.

62. Anti-Cyclic Citrullinated Peptide (anti-CCP):
Lab. tests
Anti-Cyclic Citrullinated Peptide (anti-CCP):
In high titers more specific for RA
Occurs in other disease in lower titer:
Active TB
SLE
Sjogren’s syndrome
PM/DM
Scleroderma
Prognostic value > RF
Salehi I.

63. Anti-CCP: Anti-CCP versus RF in RA: Anti-CCP: IgM-RF:
Lab. tests
Anti-CCP:
Anti-CCP versus RF in RA:
Anti-CCP:
Sensitivity: 56%, Specificity: 90%
IgM-RF:
Sensitivity: 73%, Specificity: 82%
IgM-RF + anti-CCP:
Sensitivity: 48%, Specificity: 96%
Salehi I.

64. Anti-CCP: Anti-CCP versus RF in RA: Anti-CCP: IgM-RF:
Lab. tests
Anti-CCP:
Anti-CCP versus RF in RA:
Anti-CCP:
Sensitivity: 56%, Specificity: 90%
IgM-RF:
Sensitivity: 73%, Specificity: 82%
IgM-RF + anti-CCP:
Sensitivity: 48%, Specificity: 96%
Salehi I.

65. Anti-CCP: Anti-CCP versus RF in RA: Anti-CCP: IgM-RF:
Lab. tests
Anti-CCP:
Anti-CCP versus RF in RA:
Anti-CCP:
Sensitivity: 56%, Specificity: 90%
IgM-RF:
Sensitivity: 73%, Specificity: 82%
IgM-RF + anti-CCP:
Sensitivity: 48%, Specificity: 96%
Salehi I.

66. Anti-CCP: Anti-CCP versus RF in RA: Anti-CCP: IgM-RF:
Lab. tests
Anti-CCP:
Anti-CCP versus RF in RA:
Anti-CCP:
Sensitivity: 56%, Specificity: 90%
IgM-RF:
Sensitivity: 73%, Specificity: 82%
IgM-RF + anti-CCP:
Sensitivity: 48%, Specificity: 96%
Salehi I.

67. Anti-CCP: In early undifferentiated arthritis:
Lab. tests
Anti-CCP:
In early undifferentiated arthritis:
High titer of (IgM-RF + anti-CCP) = RA
Both RF and anti-CCP negative R/O RA
Nonscreening test in normal population
Anti-Mutated Citrullinated Vimentin (anti-MCV) in RA:
More sensitive than anti-CCP
Equal specificity with anti-CCP
Prognostic value more than anti-CCP
Salehi I.

68. Anti-CCP: In early undifferentiated arthritis:
Lab. tests
Anti-CCP:
In early undifferentiated arthritis:
High titer of (IgM-RF + anti-CCP) = RA
Both RF and anti-CCP negative R/O RA
Nonscreening test in normal population
Anti-Mutated Citrullinated Vimentin (anti-MCV) in RA:
More sensitive than anti-CCP
Equal specificity with anti-CCP
Prognostic value more than anti-CCP
Salehi I.

69. Anti-CCP: In early undifferentiated arthritis:
Lab. tests
Anti-CCP:
In early undifferentiated arthritis:
High titer of (IgM-RF + anti-CCP) = RA
Both RF and anti-CCP negative R/O RA
Nonscreening test in normal population
Anti-Mutated Citrullinated Vimentin (anti-MCV) in RA:
More sensitive than anti-CCP
Equal specificity with anti-CCP
Prognostic value more than anti-CCP
Salehi I.

70. Anti-CCP: In early undifferentiated arthritis:
Lab. tests
Anti-CCP:
In early undifferentiated arthritis:
High titer of (IgM-RF + anti-CCP) = RA
Both RF and anti-CCP negative R/O RA
Nonscreening test in normal population
Anti-Mutated Citrullinated Vimentin (anti-MCV) in RA:
More sensitive than anti-CCP
Equal specificity with anti-CCP
Prognostic value more than anti-CCP
Salehi I.

71. Anti-Nuclear Antibody (ANA)
Lab. tests
Anti-Nuclear Antibody (ANA)
Nonspecific for SLE
Seen in:
Systemic autoimmune disease
Specific organ autoimmune disease
Nonautoimmune disease
Normal population
Sensitivity:
SLE: 93%
Scleroderma: 85%
MCTD: 93%
Sjogren’s synd.: 48%
Salehi I.

72. Anti-Nuclear Antibody (ANA)
Lab. tests
Anti-Nuclear Antibody (ANA)
Nonspecific for SLE
Seen in:
Systemic autoimmune disease
Specific organ autoimmune disease
Nonautoimmune disease
Normal population
Sensitivity:
SLE: 93%
Scleroderma: 85%
MCTD: 93%
Sjogren’s synd.: 48%
Salehi I.

73. Anti-Nuclear Antibody (ANA)
Lab. tests
Anti-Nuclear Antibody (ANA)
Nonspecific for SLE
Seen in:
Systemic autoimmune disease
Specific organ autoimmune disease
Nonautoimmune disease
Normal population
Sensitivity:
SLE: 93%
Scleroderma: 85%
MCTD: 93%
Sjogren’s synd.: 48%
Salehi I.

74. Anti-Nuclear Antibody (ANA)
Lab. tests
Anti-Nuclear Antibody (ANA)
Nonspecific for SLE
Seen in:
Systemic autoimmune disease
Specific organ autoimmune disease
Nonautoimmune disease
Normal population
Sensitivity:
SLE: 93%
Scleroderma: 85%
MCTD: 93%
Sjogren’s synd.: 48%
Salehi I.

75. ANA: Negative ANA: no rule out SLE Positive ANA: no equal to SLE
Lab. tests
ANA:
Negative ANA: no rule out SLE
Positive ANA: no equal to SLE
Higher titer:
> 1/160: probably autoimmune d.
> 1/640: only seen in autoimmune d.
FANA pattern:
Homogeneous or diffuse
Peripheral or rim
Speckled
Nucleolar
Centromeric
Salehi I.

76. ANA: Negative ANA: no rule out SLE Positive ANA: no equal to SLE
Lab. tests
ANA:
Negative ANA: no rule out SLE
Positive ANA: no equal to SLE
Higher titer:
> 1/160: probably autoimmune d.
> 1/640: only seen in autoimmune d.
FANA pattern:
Homogeneous or diffuse
Peripheral or rim
Speckled
Nucleolar
Centromeric
Salehi I.

77. ANA: Negative ANA: no rule out SLE Positive ANA: no equal to SLE
Lab. tests
ANA:
Negative ANA: no rule out SLE
Positive ANA: no equal to SLE
Higher titer:
> 1/160: probably autoimmune d.
> 1/640: only seen in autoimmune d.
FANA pattern:
Homogeneous or diffuse
Peripheral or rim
Speckled
Nucleolar
Centromeric
Salehi I.

78. ANA: Negative ANA: no rule out SLE Positive ANA: no equal to SLE
Lab. tests
ANA:
Negative ANA: no rule out SLE
Positive ANA: no equal to SLE
Higher titer:
> 1/160: probably autoimmune d.
> 1/640: only seen in autoimmune d.
FANA pattern:
Homogeneous or diffuse
Peripheral or rim
Speckled
Nucleolar
Centromeric
Salehi I.

79. ANA: Negative ANA: no rule out SLE Positive ANA: no equal to SLE
Lab. tests
ANA:
Negative ANA: no rule out SLE
Positive ANA: no equal to SLE
Higher titer:
> 1/160: probably autoimmune d.
> 1/640: only seen in autoimmune d.
FANA pattern:
Homogeneous or diffuse
Peripheral or rim
Speckled
Nucleolar
Centromeric
Salehi I.

80. ANA: Nonscreening test in NL population
Lab. tests
ANA:
Nonscreening test in NL population
Screening test in symptomatic Pt.
If ANA is negative in patients suspicious to have autoimmune d. we recommend:
Anti-dsDNA, Anti-Sm
Anti-RNP
ACA, Anti-Scl-70
Anti-Ro, Anti-La
Salehi I.

81. ANA: Nonscreening test in NL population
Lab. tests
ANA:
Nonscreening test in NL population
Screening test in symptomatic Pt.
If ANA is negative in patients suspicious to have autoimmune d. we recommend:
Anti-dsDNA, Anti-Sm
Anti-RNP
ACA, Anti-Scl-70
Anti-Ro, Anti-La
Salehi I.

82. ANA: Nonscreening test in NL population
Lab. tests
ANA:
Nonscreening test in NL population
Screening test in symptomatic Pt.
If ANA is negative in patients suspicious to have autoimmune d. we recommend:
Anti-dsDNA, Anti-Sm
Anti-RNP
ACA, Anti-Scl-70
Anti-Ro, Anti-La
Salehi I.

83. ANA: Nonscreening test in NL population
Lab. tests
ANA:
Nonscreening test in NL population
Screening test in symptomatic Pt.
If ANA is negative in patients suspicious to have autoimmune d. we recommend:
Anti-dsDNA, Anti-Sm
Anti-RNP
ACA, Anti-Scl-70
Anti-Ro, Anti-La
Salehi I.

84. Anti-dsDNA: Specificity: 97% Sensitivity: 70%
Lab. tests
Anti-dsDNA:
Specificity: 97%
Sensitivity: 70%
Correlate with SLE activity but not always
Titer of anti-dsDNA:
High titer: 100% specificity
Low titer seen in others (< 5%)
Peripheral or rim pattern
Induced by Infliximab & Etanercept
Salehi I.

85. Anti-dsDNA: Specificity: 97% Sensitivity: 70%
Lab. tests
Anti-dsDNA:
Specificity: 97%
Sensitivity: 70%
Correlate with SLE activity but not always
Titer of anti-dsDNA:
High titer: 100% specificity
Low titer seen in others (< 5%)
Peripheral or rim pattern
Induced by Infliximab & Etanercept
Salehi I.

86. Anti-dsDNA: Specificity: 97% Sensitivity: 70%
Lab. tests
Anti-dsDNA:
Specificity: 97%
Sensitivity: 70%
Correlate with SLE activity but not always
Titer of anti-dsDNA:
High titer: 100% specificity
Low titer seen in others (< 5%)
Peripheral or rim pattern
Induced by Infliximab & Etanercept
Salehi I.

87. Anti-dsDNA: Specificity: 97% Sensitivity: 70%
Lab. tests
Anti-dsDNA:
Specificity: 97%
Sensitivity: 70%
Correlate with SLE activity but not always
Titer of anti-dsDNA:
High titer: 100% specificity
Low titer seen in others (< 5%)
Peripheral or rim pattern
Induced by Infliximab & Etanercept
Salehi I.

88. Anti-dsDNA: Specificity: 97% Sensitivity: 70%
Lab. tests
Anti-dsDNA:
Specificity: 97%
Sensitivity: 70%
Correlate with SLE activity but not always
Titer of anti-dsDNA:
High titer: 100% specificity
Low titer seen in others (< 5%)
Peripheral or rim pattern
Induced by Infliximab & Etanercept
Salehi I.

89. Anti-dsDNA: Specificity: 97% Sensitivity: 70%
Lab. tests
Anti-dsDNA:
Specificity: 97%
Sensitivity: 70%
Correlate with SLE activity but not always
Titer of anti-dsDNA:
High titer: 100% specificity
Low titer seen in others (< 5%)
Peripheral or rim pattern
Induced by Infliximab & Etanercept
Salehi I.

90. Anti-dsDNA: Specificity: 97% Sensitivity: 70%
Lab. tests
Anti-dsDNA:
Specificity: 97%
Sensitivity: 70%
Correlate with SLE activity but not always
Titer of anti-dsDNA:
High titer: 100% specificity
Low titer seen in others (< 5%)
Peripheral or rim pattern
Induced by Infliximab & Etanercept
Salehi I.

91. Anti-Sm antibody: Specificity: 100% for SLE Sensitivity: 10-50%
Lab. tests
Anti-Sm antibody:
Specificity: 100% for SLE
Sensitivity: 10-50%
No correlation with SLE activity
We recommend anti-Sm in suspicious case of SLE with negative anti-dsDNA
With less than 4 ACR criteria, if including anti-dsDNA or anti-Sm
We have definite Dx of SLE
Salehi I.

92. Anti-Sm antibody: Specificity: 100% for SLE Sensitivity: 10-50%
Lab. tests
Anti-Sm antibody:
Specificity: 100% for SLE
Sensitivity: 10-50%
No correlation with SLE activity
We recommend anti-Sm in suspicious case of SLE with negative anti-dsDNA
With less than 4 ACR criteria, if including anti-dsDNA or anti-Sm
We have definite Dx of SLE
Salehi I.

93. Anti-Sm antibody: Specificity: 100% for SLE Sensitivity: 10-50%
Lab. tests
Anti-Sm antibody:
Specificity: 100% for SLE
Sensitivity: 10-50%
No correlation with SLE activity
We recommend anti-Sm in suspicious case of SLE with negative anti-dsDNA
With less than 4 ACR criteria, if including anti-dsDNA or anti-Sm
We have definite Dx of SLE
Salehi I.

94. Anti-Sm antibody: Specificity: 100% for SLE Sensitivity: 10-50%
Lab. tests
Anti-Sm antibody:
Specificity: 100% for SLE
Sensitivity: 10-50%
No correlation with SLE activity
We recommend anti-Sm in suspicious case of SLE with negative anti-dsDNA
With less than 4 ACR criteria, if including anti-dsDNA or anti-Sm
We have definite Dx of SLE
Salehi I.

95. Anti-Sm antibody: Specificity: 100% for SLE Sensitivity: 10-50%
Lab. tests
Anti-Sm antibody:
Specificity: 100% for SLE
Sensitivity: 10-50%
No correlation with SLE activity
We recommend anti-Sm in suspicious case of SLE with negative anti-dsDNA
With less than 4 ACR criteria, if including anti-dsDNA or anti-Sm
We have definite Dx of SLE
Salehi I.

96. Anti-Sm antibody: Specificity: 100% for SLE Sensitivity: 10-50%
Lab. tests
Anti-Sm antibody:
Specificity: 100% for SLE
Sensitivity: 10-50%
No correlation with SLE activity
We recommend anti-Sm in suspicious case of SLE with negative anti-dsDNA
With less than 4 ACR criteria, if including anti-dsDNA or anti-Sm
We have definite Dx of SLE
Salehi I.

97. Anti-Neutrophil Cytoplasmic Antibody (ANCA):
Lab. tests
Anti-Neutrophil Cytoplasmic Antibody (ANCA):
IF assay: more sensitive
C-ANCA
P-ANCA
Atypical (non-C, non-P) ANCA
ELISA: more specific
PR3-ANCA
MPO-ANCA
C-ANCA: usually PR3-ANCA
P-ANCA: usually MPO-ANCA
Salehi I.

98. Anti-Neutrophil Cytoplasmic Antibody (ANCA):
Lab. tests
Anti-Neutrophil Cytoplasmic Antibody (ANCA):
IF assay: more sensitive
C-ANCA
P-ANCA
Atypical (non-C, non-P) ANCA
ELISA: more specific
PR3-ANCA
MPO-ANCA
C-ANCA: usually PR3-ANCA
P-ANCA: usually MPO-ANCA
Salehi I.

99. Anti-Neutrophil Cytoplasmic Antibody (ANCA):
Lab. tests
Anti-Neutrophil Cytoplasmic Antibody (ANCA):
IF assay: more sensitive
C-ANCA
P-ANCA
Atypical (non-C, non-P) ANCA
ELISA: more specific
PR3-ANCA
MPO-ANCA
C-ANCA: usually PR3-ANCA
P-ANCA: usually MPO-ANCA
Salehi I.

100. Anti-Neutrophil Cytoplasmic Antibody (ANCA):
Lab. tests
Anti-Neutrophil Cytoplasmic Antibody (ANCA):
IF assay: more sensitive
C-ANCA
P-ANCA
Atypical (non-C, non-P) ANCA
ELISA: more specific
PR3-ANCA
MPO-ANCA
C-ANCA: usually PR3-ANCA
P-ANCA: usually MPO-ANCA
Salehi I.

101. Anti-Neutrophil Cytoplasmic Antibody (ANCA):
Lab. tests
Anti-Neutrophil Cytoplasmic Antibody (ANCA):
IF assay: more sensitive
C-ANCA
P-ANCA
Atypical (non-C, non-P) ANCA
ELISA: more specific
PR3-ANCA
MPO-ANCA
C-ANCA: usually PR3-ANCA
P-ANCA: usually MPO-ANCA
Salehi I.

102. ANCA: C-ANCA > P-ANCA: Positive ANCA in WG: Sensitivity:
Lab. tests
ANCA:
C-ANCA > P-ANCA:
specificity for vasculitis
Positive ANCA in WG:
90% in active severe WG
60% in limited WG
80-90%: PR3-ANCA
Sensitivity:
WG: 60-90%
MPA: 70%
CSS: 50%
Specificity: 81-95%
Salehi I.

103. ANCA: C-ANCA > P-ANCA: Positive ANCA in WG: Sensitivity:
Lab. tests
ANCA:
C-ANCA > P-ANCA:
specificity for vasculitis
Positive ANCA in WG:
90% in active severe WG
60% in limited WG
80-90%: PR3-ANCA
Sensitivity:
WG: 60-90%
MPA: 70%
CSS: 50%
Specificity: 81-95%
Salehi I.

104. ANCA: C-ANCA > P-ANCA: Positive ANCA in WG: Sensitivity:
Lab. tests
ANCA:
C-ANCA > P-ANCA:
specificity for vasculitis
Positive ANCA in WG:
90% in active severe WG
60% in limited WG
80-90%: PR3-ANCA
Sensitivity:
WG: 60-90%
MPA: 70%
CSS: 50%
Specificity: 81-95%
Salehi I.

105. ANCA: C-ANCA > P-ANCA: Positive ANCA in WG: Sensitivity:
Lab. tests
ANCA:
C-ANCA > P-ANCA:
specificity for vasculitis
Positive ANCA in WG:
90% in active severe WG
60% in limited WG
80-90%: PR3-ANCA
Sensitivity:
WG: 60-90%
MPA: 70%
CSS: 50%
Specificity: 81-95%
Salehi I.

106. ANCA: C-ANCA > P-ANCA: Positive ANCA in WG: Sensitivity:
Lab. tests
ANCA:
C-ANCA > P-ANCA:
specificity for vasculitis
Positive ANCA in WG:
90% in active severe WG
60% in limited WG
80-90%: PR3-ANCA
Sensitivity:
WG: 60-90%
MPA: 70%
CSS: 50%
Specificity: 81-95%
Salehi I.

107. Lab. tests
ANCA:
Positive predictive value of ANCA for ANCA associated vasculitis:
IF: 45%, ELISA: 83%, IF + ELISA: 88%
in acute or rapidly progressive GN: 98%
in chronic sinusitis: very low for WG
in systemic disease (C-ANCA):
50% for ANCA associated vasculitis
28% for WG
Salehi I.

108. Lab. tests
ANCA:
Positive predictive value of ANCA for ANCA associated vasculitis:
IF: 45%, ELISA: 83%, IF + ELISA: 88%
in acute or rapidly progressive GN: 98%
in chronic sinusitis: very low for WG
in systemic disease (C-ANCA):
50% for ANCA associated vasculitis
28% for WG
Salehi I.

109. Lab. tests
ANCA:
Positive predictive value of ANCA for ANCA associated vasculitis:
IF: 45%, ELISA: 83%, IF + ELISA: 88%
in acute or rapidly progressive GN: 98%
in chronic sinusitis: very low for WG
in systemic disease (C-ANCA):
50% for ANCA associated vasculitis
28% for WG
Salehi I.

110. Lab. tests
ANCA:
Positive predictive value of ANCA for ANCA associated vasculitis:
IF: 45%, ELISA: 83%, IF + ELISA: 88%
in acute or rapidly progressive GN: 98%
in chronic sinusitis: very low for WG
in systemic disease (C-ANCA):
50% for ANCA associated vasculitis
28% for WG
Salehi I.

111. Lab. tests
ANCA:
Positive predictive value of ANCA for ANCA associated vasculitis:
IF: 45%, ELISA: 83%, IF + ELISA: 88%
in acute or rapidly progressive GN: 98%
in chronic sinusitis: very low for WG
in systemic disease (C-ANCA):
50% for ANCA associated vasculitis
28% for WG
Salehi I.

112. Lab. tests
ANCA:
Positive predictive value of ANCA for ANCA associated vasculitis:
IF: 45%, ELISA: 83%, IF + ELISA: 88%
in acute or rapidly progressive GN: 98%
in chronic sinusitis: very low for WG
in systemic disease (C-ANCA):
50% for ANCA associated vasculitis
28% for WG
Salehi I.

113. ANCA: Negative predictive value: Correlation with disease activity:
Lab. tests
ANCA:
Negative predictive value:
With IF + ELISA
in acute or rapidly progressive GN
for ANCA associated vasculitis
Is: 99%
Correlation with disease activity:
IF: 57%, ELISA: 71%
FANA  false positive P-ANCA
Salehi I.

114. ANCA: Negative predictive value: Correlation with disease activity:
Lab. tests
ANCA:
Negative predictive value:
With IF + ELISA
in acute or rapidly progressive GN
for ANCA associated vasculitis
Is: 99%
Correlation with disease activity:
IF: 57%, ELISA: 71%
FANA  false positive P-ANCA
Salehi I.

115. ANCA: Negative predictive value: Correlation with disease activity:
Lab. tests
ANCA:
Negative predictive value:
With IF + ELISA
in acute or rapidly progressive GN
for ANCA associated vasculitis
Is: 99%
Correlation with disease activity:
IF: 57%, ELISA: 71%
FANA  false positive P-ANCA
Salehi I.

116. ANCA: Negative predictive value: Correlation with disease activity:
Lab. tests
ANCA:
Negative predictive value:
With IF + ELISA
in acute or rapidly progressive GN
for ANCA associated vasculitis
Is: 99%
Correlation with disease activity:
IF: 57%, ELISA: 71%
FANA  false positive P-ANCA
Salehi I.

117. Anti-Phospholipid (APL) Antibodies:
Lab. tests
Anti-Phospholipid (APL) Antibodies:
Lupus Anticoagulant (LA)
Anticardiolipin (aCL) antibodies
Anti B2-Glycoprotein-I (B2-GP-I)
Biologic False Positive test for syphilis:
VDRL, RPR
Low sensitivity, Low specificity
Nonscreening tests for APS
Seen in SLE too
Salehi I.

118. Anti-Phospholipid (APL) Antibodies:
Lab. tests
Anti-Phospholipid (APL) Antibodies:
Lupus Anticoagulant (LA)
Anticardiolipin (aCL) antibodies
Anti B2-Glycoprotein-I (B2-GP-I)
Biologic False Positive test for syphilis:
VDRL, RPR
Low sensitivity, Low specificity
Nonscreening tests for APS
Seen in SLE too
Salehi I.

119. Anti-Phospholipid (APL) Antibodies:
Lab. tests
Anti-Phospholipid (APL) Antibodies:
Lupus Anticoagulant (LA)
Anticardiolipin (aCL) antibodies
Anti B2-Glycoprotein-I (B2-GP-I)
Biologic False Positive test for syphilis:
VDRL, RPR
Low sensitivity, Low specificity
Nonscreening tests for APS
Seen in SLE too
Salehi I.

120. Anti-Phospholipid (APL) Antibodies:
Lab. tests
Anti-Phospholipid (APL) Antibodies:
Lupus Anticoagulant (LA)
Anticardiolipin (aCL) antibodies
Anti B2-Glycoprotein-I (B2-GP-I)
Biologic False Positive test for syphilis:
VDRL, RPR
Low sensitivity, Low specificity
Nonscreening tests for APS
Seen in SLE too
Salehi I.

121. Anti-Phospholipid (APL) Antibodies:
Lab. tests
Anti-Phospholipid (APL) Antibodies:
Lupus Anticoagulant (LA)
Anticardiolipin (aCL) antibodies
Anti B2-Glycoprotein-I (B2-GP-I)
Biologic False Positive test for syphilis:
VDRL, RPR
Low sensitivity, Low specificity
Nonscreening tests for APS
Seen in SLE too
Salehi I.

122. APL Antibodies: When APS is suspected we recommend: First step:
Lab. tests
APL Antibodies:
When APS is suspected we recommend:
First step:
aCL and LA,
if negative
Second step:
Anti-B2-GP-I antibody
Anti-Prothrombin
Antiphosphatidyl inositol
Only aCL and LA are diagnostic criteria
Salehi I.

123. APL Antibodies: When APS is suspected we recommend: First step:
Lab. tests
APL Antibodies:
When APS is suspected we recommend:
First step:
aCL and LA,
if negative
Second step:
Anti-B2-GP-I antibody
Anti-Prothrombin
Antiphosphatidyl inositol
Only aCL and LA are diagnostic criteria
Salehi I.

124. APL Antibodies: When APS is suspected we recommend: First step:
Lab. tests
APL Antibodies:
When APS is suspected we recommend:
First step:
aCL and LA,
if negative
Second step:
Anti-B2-GP-I antibody
Anti-Prothrombin
Antiphosphatidyl inositol
Only aCL and LA are diagnostic criteria
Salehi I.

125. APL Antibodies: When APS is suspected we recommend: First step:
Lab. tests
APL Antibodies:
When APS is suspected we recommend:
First step:
aCL and LA,
if negative
Second step:
Anti-B2-GP-I antibody
Anti-Prothrombin
Antiphosphatidyl inositol
Only aCL and LA are diagnostic criteria
Salehi I.

126. Scleroderma related antibodies:
Lab. tests
Scleroderma related antibodies:
Anti-topoisomerase-I (anti-Scl-70):
More associated with Diffuse Scl.
Sensitivity: until 43%
Specificity: until 98%
Anti-Centromere Antibody (ACA):
Usually associated with Limited Scl.
Sensitivity: until 33%
Specificity: until 95%
Salehi I.

127. Scleroderma related antibodies:
Lab. tests
Scleroderma related antibodies:
Anti-topoisomerase-I (anti-Scl-70):
More associated with Diffuse Scl.
Sensitivity: until 43%
Specificity: until 98%
Anti-Centromere Antibody (ACA):
Usually associated with Limited Scl.
Sensitivity: until 33%
Specificity: until 95%
Salehi I.

128. Scleroderma related antibodies:
Lab. tests
Scleroderma related antibodies:
Anti-topoisomerase-I (anti-Scl-70):
More associated with Diffuse Scl.
Sensitivity: until 43%
Specificity: until 98%
Anti-Centromere Antibody (ACA):
Usually associated with Limited Scl.
Sensitivity: until 33%
Specificity: until 95%
Salehi I.

129. Scleroderma related antibodies:
Lab. tests
Scleroderma related antibodies:
Anti RNA polymerase
Anti-PM-Scl: Overlap of PM + Scl
Anti-Fibrillin-1: Localized Scl.
Anti-Nucleolus Organizer Region (NOR-90)
Anti-Nucleolar RNA helicase (Gu): Scl. + SLE
Salehi I.

130. Scleroderma related antibodies:
Lab. tests
Scleroderma related antibodies:
Anti RNA polymerase
Anti-PM-Scl: Overlap of PM + Scl
Anti-Fibrillin-1: Localized Scl.
Anti-Nucleolus Organizer Region (NOR-90)
Anti-Nucleolar RNA helicase (Gu): Scl. + SLE
Salehi I.

131. Scleroderma related antibodies:
Lab. tests
Scleroderma related antibodies:
Anti RNA polymerase
Anti-PM-Scl: Overlap of PM + Scl
Anti-Fibrillin-1: Localized Scl.
Anti-Nucleolus Organizer Region (NOR-90)
Anti-Nucleolar RNA helicase (Gu): Scl. + SLE
Salehi I.

132. Anti-Ro/SSA, Anti-La/SSB:
Lab. tests
Anti-Ro/SSA, Anti-La/SSB:
Seen in:
Sjogren’s syndrome
SLE (SCLE), Neonatal lupus (CCHB)
Others
NL population: %
Nonspecific
Anti-Ro sensitivity:
Primary Sjogren: 70-97%
SLE: 10-60%
Anti-La sensitivity:
Primary Sjogren: 70-95%
SLE: 10-35%
Salehi I.

133. Anti-Ro/SSA, Anti-La/SSB:
Lab. tests
Anti-Ro/SSA, Anti-La/SSB:
Seen in:
Sjogren’s syndrome
SLE (SCLE), Neonatal lupus (CCHB)
Others
NL population: %
Nonspecific
Anti-Ro sensitivity:
Primary Sjogren: 70-97%
SLE: 10-60%
Anti-La sensitivity:
Primary Sjogren: 70-95%
SLE: 10-35%
Salehi I.

134. Anti-Ro/SSA, Anti-La/SSB:
Lab. tests
Anti-Ro/SSA, Anti-La/SSB:
Seen in:
Sjogren’s syndrome
SLE (SCLE), Neonatal lupus (CCHB)
Others
NL population: %
Nonspecific
Anti-Ro sensitivity:
Primary Sjogren: 70-97%
SLE: 10-60%
Anti-La sensitivity:
Primary Sjogren: 70-95%
SLE: 10-35%
Salehi I.

135. Anti-Ro/SSA, Anti-La/SSB:
Lab. tests
Anti-Ro/SSA, Anti-La/SSB:
Seen in:
Sjogren’s syndrome
SLE (SCLE), Neonatal lupus (CCHB)
Others
NL population: %
Nonspecific
Anti-Ro sensitivity:
Primary Sjogren: 70-97%
SLE: 10-60%
Anti-La sensitivity:
Primary Sjogren: 70-95%
SLE: 10-35%
Salehi I.

136. Anti-Ro/SSA, Anti-La/SSB:
Lab. tests
Anti-Ro/SSA, Anti-La/SSB:
Seen in:
Sjogren’s syndrome
SLE (SCLE), Neonatal lupus (CCHB)
Others
NL population: %
Nonspecific
Anti-Ro sensitivity:
Primary Sjogren: 70-97%
SLE: 10-60%
Anti-La sensitivity:
Primary Sjogren: 70-95%
SLE: 10-35%
Salehi I.

137. Anti-Ro/SSA, Anti-La/SSB:
Lab. tests
Anti-Ro/SSA, Anti-La/SSB:
Indication for ordering:
Women with SLE who have become pregnant
Women with past Hx of CCHB or myocarditis in her neonate
Photosensitive skin eruption
ANA negative systemic CTD
Xerostomia and Keratoconjunctivitis sicca
Bilateral salivary and lacrimal gland enlargement
Salehi I.

138. Anti-Ro/SSA, Anti-La/SSB:
Lab. tests
Anti-Ro/SSA, Anti-La/SSB:
Indication for ordering:
Women with SLE who have become pregnant
Women with past Hx of CCHB or myocarditis in her neonate
Photosensitive skin eruption
ANA negative systemic CTD
Xerostomia and Keratoconjunctivitis sicca
Bilateral salivary and lacrimal gland enlargement
Salehi I.

139. Anti-Ro/SSA, Anti-La/SSB:
Lab. tests
Anti-Ro/SSA, Anti-La/SSB:
Indication for ordering:
Women with SLE who have become pregnant
Women with past Hx of CCHB or myocarditis in her neonate
Photosensitive skin eruption
ANA negative systemic CTD
Xerostomia and Keratoconjunctivitis sicca
Bilateral salivary and lacrimal gland enlargement
Salehi I.

140. Anti-Ro/SSA, Anti-La/SSB:
Lab. tests
Anti-Ro/SSA, Anti-La/SSB:
Indication for ordering:
Women with SLE who have become pregnant
Women with past Hx of CCHB or myocarditis in her neonate
Photosensitive skin eruption
ANA negative systemic CTD
Xerostomia and Keratoconjunctivitis sicca
Bilateral salivary and lacrimal gland enlargement
Salehi I.

141. Anti-Ro/SSA, Anti-La/SSB:
Lab. tests
Anti-Ro/SSA, Anti-La/SSB:
Indication for ordering:
Women with SLE who have become pregnant
Women with past Hx of CCHB or myocarditis in her neonate
Photosensitive skin eruption
ANA negative systemic CTD
Xerostomia and Keratoconjunctivitis sicca
Bilateral salivary and lacrimal gland enlargement
Salehi I.

142. Anti-Ro/SSA, Anti-La/SSB:
Lab. tests
Anti-Ro/SSA, Anti-La/SSB:
Indication for ordering:
Women with SLE who have become pregnant
Women with past Hx of CCHB or myocarditis in her neonate
Photosensitive skin eruption
ANA negative systemic CTD
Xerostomia and Keratoconjunctivitis sicca
Bilateral salivary and lacrimal gland enlargement
Salehi I.

143. Anti-Ro/SSA, Anti-La/SSB:
Lab. tests
Anti-Ro/SSA, Anti-La/SSB:
Indication for ordering:
Women with SLE who have become pregnant
Women with past Hx of CCHB or myocarditis in her neonate
Photosensitive skin eruption
ANA negative systemic CTD
Xerostomia and Keratoconjunctivitis sicca
Bilateral salivary and lacrimal gland enlargement
Salehi I.

144. Anti-Ro/SSA, Anti-La/SSB:
Lab. tests
Anti-Ro/SSA, Anti-La/SSB:
Indication for ordering:
Women with SLE who have become pregnant
Women with past Hx of CCHB or myocarditis in her neonate
Photosensitive skin eruption
ANA negative systemic CTD
Xerostomia and Keratoconjunctivitis sicca
Bilateral salivary and lacrimal gland enlargement
Salehi I.

145. Myositis Specific Autoantibody (MSA):
Lab. tests
Myositis Specific Autoantibody (MSA):
Anti-JO-1:
Most common MSA
Anti-JO-1 syndrome
Anti-SRP:
Almost exclusively in PM
Severe uncontroled myositis
Anti-Mi-2:
Acute DM with erythroderma
Salehi I.

146. Myositis Specific Autoantibody (MSA):
Lab. tests
Myositis Specific Autoantibody (MSA):
Anti-JO-1:
Most common MSA
Anti-JO-1 syndrome
Anti-SRP:
Almost exclusively in PM
Severe uncontroled myositis
Anti-Mi-2:
Acute DM with erythroderma
Salehi I.

147. Myositis Specific Autoantibody (MSA):
Lab. tests
Myositis Specific Autoantibody (MSA):
Anti-JO-1:
Most common MSA
Anti-JO-1 syndrome
Anti-SRP:
Almost exclusively in PM
Severe uncontroled myositis
Anti-Mi-2:
Acute DM with erythroderma
Salehi I.

148. Myositis Specific Autoantibody (MSA):
Lab. tests
Myositis Specific Autoantibody (MSA):
Anti-JO-1:
Most common MSA
Anti-JO-1 syndrome
Anti-SRP:
Almost exclusively in PM
Severe uncontroled myositis
Anti-Mi-2:
Acute DM with erythroderma
Salehi I.

149. MSA: Anti-CADM-140: Anti-155/140: Anti-hPMS-1 Anti-Ku Anti-155 KD Pr.
Lab. tests
MSA:
Anti-CADM-140:
Amyopathic DM
Anti-155/140:
DM + Malignancy
Anti-hPMS-1
Anti-Ku
Anti-155 KD Pr.
Salehi I.

150. MSA: Anti-CADM-140: Anti-155/140: Anti-hPMS-1 Anti-Ku Anti-155 KD Pr.
Lab. tests
MSA:
Anti-CADM-140:
Amyopathic DM
Anti-155/140:
DM + Malignancy
Anti-hPMS-1
Anti-Ku
Anti-155 KD Pr.
Salehi I.

151. MSA: Anti-CADM-140: Anti-155/140: Anti-hPMS-1 Anti-Ku Anti-155 KD Pr.
Lab. tests
MSA:
Anti-CADM-140:
Amyopathic DM
Anti-155/140:
DM + Malignancy
Anti-hPMS-1
Anti-Ku
Anti-155 KD Pr.
Salehi I.

152. Anti-RNP: High titer of Anti-U1 RNP: Medium to Low titer:
Lab. tests
Anti-RNP:
High titer of Anti-U1 RNP:
More specific for MCTD
Diagnostic criteria for MCTD
Medium to Low titer:
SLE: 3-69%
Low titer: Others
Salehi I.

153. Anti-RNP: High titer of Anti-U1 RNP: Medium to Low titer:
Lab. tests
Anti-RNP:
High titer of Anti-U1 RNP:
More specific for MCTD
Diagnostic criteria for MCTD
Medium to Low titer:
SLE: 3-69%
Low titer: Others
Salehi I.

154. Anti-RNP: High titer of Anti-U1 RNP: Medium to Low titer:
Lab. tests
Anti-RNP:
High titer of Anti-U1 RNP:
More specific for MCTD
Diagnostic criteria for MCTD
Medium to Low titer:
SLE: 3-69%
Low titer: Others
Salehi I.

155. Anti-RNP: High titer of Anti-U1 RNP: Medium to Low titer:
Lab. tests
Anti-RNP:
High titer of Anti-U1 RNP:
More specific for MCTD
Diagnostic criteria for MCTD
Medium to Low titer:
SLE: 3-69%
Low titer: Others
Salehi I.

156. Anti-Perinuclear Factor Antibody (APF), Anti-Keratin Antibody (AKA):
Lab. tests
Anti-Perinuclear Factor Antibody (APF), Anti-Keratin Antibody (AKA):
The most specific antibodies for RA
React with CCP in the filaggrin molecule
Anti-CCP has replaced these tests
More easier to perform than
More standardize than
Salehi I.

157. Anti-Perinuclear Factor Antibody (APF), Anti-Keratin Antibody (AKA):
Lab. tests
Anti-Perinuclear Factor Antibody (APF), Anti-Keratin Antibody (AKA):
The most specific antibodies for RA
React with CCP in the filaggrin molecule
Anti-CCP has replaced these tests
More easier to perform than
More standardize than
Salehi I.

158. Anti-Perinuclear Factor Antibody (APF), Anti-Keratin Antibody (AKA):
Lab. tests
Anti-Perinuclear Factor Antibody (APF), Anti-Keratin Antibody (AKA):
The most specific antibodies for RA
React with CCP in the filaggrin molecule
Anti-CCP has replaced these tests
More easier to perform than
More standardize than
Salehi I.

159. Anti-Perinuclear Factor Antibody (APF), Anti-Keratin Antibody (AKA):
Lab. tests
Anti-Perinuclear Factor Antibody (APF), Anti-Keratin Antibody (AKA):
The most specific antibodies for RA
React with CCP in the filaggrin molecule
Anti-CCP has replaced these tests
More easier to perform than
More standardize than
Salehi I.

160. Other Autoantibodies:
Lab. tests
Other Autoantibodies:
Anti-Chromatin antibody: LE factor
Anti-PCNA:
Specificity > 95% in SLE
But very low sensitive (< 5%)
Anti-hnRP: Nonspecific, low sensitive
Anti-HMG: in JRA, nonpractical
Anti-BiP: in RA, nonpractical
Anti-RA33: Nonspecific for RA, nonpractical
Salehi I.

161. Other Autoantibodies:
Lab. tests
Other Autoantibodies:
Anti-Chromatin antibody: LE factor
Anti-PCNA:
Specificity > 95% in SLE
But very low sensitive (< 5%)
Anti-hnRP: Nonspecific, low sensitive
Anti-HMG: in JRA, nonpractical
Anti-BiP: in RA, nonpractical
Anti-RA33: Nonspecific for RA, nonpractical
Salehi I.

162. Other Autoantibodies:
Lab. tests
Other Autoantibodies:
Anti-Sa antibody:
An diagnostic and predictive test for RA
Sensitivity: 68%, Specificity: 79%
useful when RF and Anti-CCP are negative but RA is still suspected
Gal O glycoform:
IgG lacking galactose
Increased in RA
Combination of Gal O IgG and RF test
Sensitivity: 90%
Specificity: 95%
Predictive value: 94%
Salehi I.

163. Other Autoantibodies:
Lab. tests
Other Autoantibodies:
Anti-Sa antibody:
An diagnostic and predictive test for RA
Sensitivity: 68%, Specificity: 79%
useful when RF and Anti-CCP are negative but RA is still suspected
Gal O glycoform:
IgG lacking galactose
Increased in RA
Combination of Gal O IgG and RF test
Sensitivity: 90%
Specificity: 95%
Predictive value: 94%
Salehi I.

164. Other Autoantibodies:
Lab. tests
Other Autoantibodies:
Anti-Sa antibody:
An diagnostic and predictive test for RA
Sensitivity: 68%, Specificity: 79%
useful when RF and Anti-CCP are negative but RA is still suspected
Gal O glycoform:
IgG lacking galactose
Increased in RA
Combination of Gal O IgG and RF test
Sensitivity: 90%
Specificity: 95%
Predictive value: 94%
Salehi I.

165. Complement: CH50: AH50: Classical pathway activation:
Lab. tests
Complement:
CH50:
Total hemolytic complement
Total Classical pathway
AH50:
Total Alternative pathway
Classical pathway activation:
Decreased C3 & C4
Normal Factor B
Alternative pathway activation:
Decreased C3 & Factor B
Normal C4
Both pathway activation:
Decreased C4 & Factor B
Salehi I.

166. Complement: CH50: AH50: Classical pathway activation:
Lab. tests
Complement:
CH50:
Total hemolytic complement
Total Classical pathway
AH50:
Total Alternative pathway
Classical pathway activation:
Decreased C3 & C4
Normal Factor B
Alternative pathway activation:
Decreased C3 & Factor B
Normal C4
Both pathway activation:
Decreased C4 & Factor B
Salehi I.

167. Complement: CH50: AH50: Classical pathway activation:
Lab. tests
Complement:
CH50:
Total hemolytic complement
Total Classical pathway
AH50:
Total Alternative pathway
Classical pathway activation:
Decreased C3 & C4
Normal Factor B
Alternative pathway activation:
Decreased C3 & Factor B
Normal C4
Both pathway activation:
Decreased C4 & Factor B
Salehi I.

168. Complement: CH50: AH50: Classical pathway activation:
Lab. tests
Complement:
CH50:
Total hemolytic complement
Total Classical pathway
AH50:
Total Alternative pathway
Classical pathway activation:
Decreased C3 & C4
Normal Factor B
Alternative pathway activation:
Decreased C3 & Factor B
Normal C4
Both pathway activation:
Decreased C4 & Factor B
Salehi I.

169. Complement: CH50: AH50: Classical pathway activation:
Lab. tests
Complement:
CH50:
Total hemolytic complement
Total Classical pathway
AH50:
Total Alternative pathway
Classical pathway activation:
Decreased C3 & C4
Normal Factor B
Alternative pathway activation:
Decreased C3 & Factor B
Normal C4
Both pathway activation:
Decreased C4 & Factor B
Salehi I.

170. Complement: CH50: AH50: Classical pathway activation:
Lab. tests
Complement:
CH50:
Total hemolytic complement
Total Classical pathway
AH50:
Total Alternative pathway
Classical pathway activation:
Decreased C3 & C4
Normal Factor B
Alternative pathway activation:
Decreased C3 & Factor B
Normal C4
Both pathway activation:
Decreased C4 & Factor B
Salehi I.

171. Complement: Reduced C. (C3, C4, CH50) level: C1 inhibitor (C1-Inh):
Lab. tests
Complement:
Reduced C. (C3, C4, CH50) level:
Immune Complex disease
Active SLE
Cold agglutinin syndrome
Recurrent infections
C1 inhibitor (C1-Inh):
Deficiency in:
Acquired and inherited Angioedema
Salehi I.

172. Complement: Reduced C. (C3, C4, CH50) level: C1 inhibitor (C1-Inh):
Lab. tests
Complement:
Reduced C. (C3, C4, CH50) level:
Immune Complex disease
Active SLE
Cold agglutinin syndrome
Recurrent infections
C1 inhibitor (C1-Inh):
Deficiency in:
Acquired and inherited Angioedema
Salehi I.

173. Complement: Reduced C. (C3, C4, CH50) level: C1 inhibitor (C1-Inh):
Lab. tests
Complement:
Reduced C. (C3, C4, CH50) level:
Immune Complex disease
Active SLE
Cold agglutinin syndrome
Recurrent infections
C1 inhibitor (C1-Inh):
Deficiency in:
Acquired and inherited Angioedema
Salehi I.

174. IL-6: Acute phase reactant
Lab. tests
Cryoglobulins (CG):
Cryocrit
Absolute CG concentration
Component of IC
CD40 ligand (CD154):
Upon activated T cells
Active RA
IL-6: Acute phase reactant
Salehi I.

175. IL-6: Acute phase reactant
Lab. tests
Cryoglobulins (CG):
Cryocrit
Absolute CG concentration
Component of IC
CD40 ligand (CD154):
Upon activated T cells
Active RA
IL-6: Acute phase reactant
Salehi I.

176. IL-6: Acute phase reactant
Lab. tests
Cryoglobulins (CG):
Cryocrit
Absolute CG concentration
Component of IC
CD40 ligand (CD154):
Upon activated T cells
Active RA
IL-6: Acute phase reactant
Salehi I.

177. IL-6: Acute phase reactant
Lab. tests
Cryoglobulins (CG):
Cryocrit
Absolute CG concentration
Component of IC
CD40 ligand (CD154):
Upon activated T cells
Active RA
IL-6: Acute phase reactant
Salehi I.

178. HLA typing: HLA-B27: White AS: 95%, Black AS: 50%
Lab. tests
HLA typing:
HLA-B27:
White AS: 95%, Black AS: 50%
Other SpA.; ReA: 70%, EA: 50%
Nl US population: 3-8%
Nonspecific for AS
Negative HLA-27: no rule out AS
RR for AS:
Indications:
In patients with evidence of SpA.
In patients with inflammatory LBP
In first degree family members of AS
In SpA. As prognostic factor
Salehi I.

179. HLA typing: HLA-B27: White AS: 95%, Black AS: 50%
Lab. tests
HLA typing:
HLA-B27:
White AS: 95%, Black AS: 50%
Other SpA.; ReA: 70%, EA: 50%
Nl US population: 3-8%
Nonspecific for AS
Negative HLA-27: no rule out AS
RR for AS:
Indications:
In patients with evidence of SpA.
In patients with inflammatory LBP
In first degree family members of AS
In SpA. As prognostic factor
Salehi I.

180. HLA typing: HLA-B27: White AS: 95%, Black AS: 50%
Lab. tests
HLA typing:
HLA-B27:
White AS: 95%, Black AS: 50%
Other SpA.; ReA: 70%, EA: 50%
Nl US population: 3-8%
Nonspecific for AS
Negative HLA-27: no rule out AS
RR for AS:
Indications:
In patients with evidence of SpA.
In patients with inflammatory LBP
In first degree family members of AS
In SpA. As prognostic factor
Salehi I.

181. HLA typing: HLA-B27: White AS: 95%, Black AS: 50%
Lab. tests
HLA typing:
HLA-B27:
White AS: 95%, Black AS: 50%
Other SpA.; ReA: 70%, EA: 50%
Nl US population: 3-8%
Nonspecific for AS
Negative HLA-27: no rule out AS
RR for AS:
Indications:
In patients with evidence of SpA.
In patients with inflammatory LBP
In first degree family members of AS
In SpA. As prognostic factor
Salehi I.

182. HLA typing: HLA-B27: White AS: 95%, Black AS: 50%
Lab. tests
HLA typing:
HLA-B27:
White AS: 95%, Black AS: 50%
Other SpA.; ReA: 70%, EA: 50%
Nl US population: 3-8%
Nonspecific for AS
Negative HLA-27: no rule out AS
RR for AS:
Indications:
In patients with evidence of SpA.
In patients with inflammatory LBP
In first degree family members of AS
In SpA. As prognostic factor
Salehi I.

183. HLA typing: HLA-B27: White AS: 95%, Black AS: 50%
Lab. tests
HLA typing:
HLA-B27:
White AS: 95%, Black AS: 50%
Other SpA.; ReA: 70%, EA: 50%
Nl US population: 3-8%
Nonspecific for AS
Negative HLA-27: no rule out AS
RR for AS:
Indications:
In patients with evidence of SpA.
In patients with inflammatory LBP
In first degree family members of AS
In SpA. As prognostic factor
Salehi I.

184. HLA typing: HLA-B5: HLA-DR4: HLA-B51 in Behcet’s disease (BD)
Lab. tests
HLA typing:
HLA-B5:
HLA-B51 in Behcet’s disease (BD)
Until 63% of BD
HLA-B5101 & HLA-B5108 in silk road
HLA-DR4:
In RA: 70%
In normal population: 39%
Felty syndrome
Salehi I.

185. HLA typing: HLA-B5: HLA-DR4: HLA-B51 in Behcet’s disease (BD)
Lab. tests
HLA typing:
HLA-B5:
HLA-B51 in Behcet’s disease (BD)
Until 63% of BD
HLA-B5101 & HLA-B5108 in silk road
HLA-DR4:
In RA: 70%
In normal population: 39%
Felty syndrome
Salehi I.

186. HLA typing: HLA-B5: HLA-DR4: HLA-B51 in Behcet’s disease (BD)
Lab. tests
HLA typing:
HLA-B5:
HLA-B51 in Behcet’s disease (BD)
Until 63% of BD
HLA-B5101 & HLA-B5108 in silk road
HLA-DR4:
In RA: 70%
In normal population: 39%
Felty syndrome
Salehi I.

187. Synovium-specific markers:
Lab. tests
Synovium-specific markers:
Hyaluronan
MMP-1 & MMP-3
Ig soluble receptor (FcgRIIIa)
Cartilage-specific markers:
Cartilage oligomeric matrix protein (COMP)
Epitope 846
CTX-II in urine
HELIX-II in urine
Serum level of MMP3 & CTX-II
Salehi I.

188. Synovium-specific markers:
Lab. tests
Synovium-specific markers:
Hyaluronan
MMP-1 & MMP-3
Ig soluble receptor (FcgRIIIa)
Cartilage-specific markers:
Cartilage oligomeric matrix protein (COMP)
Epitope 846
CTX-II in urine
HELIX-II in urine
Serum level of MMP3 & CTX-II
Salehi I.

189. Synovium-specific markers:
Lab. tests
Synovium-specific markers:
Hyaluronan
MMP-1 & MMP-3
Ig soluble receptor (FcgRIIIa)
Cartilage-specific markers:
Cartilage oligomeric matrix protein (COMP)
Epitope 846
CTX-II in urine
HELIX-II in urine
Serum level of MMP3 & CTX-II
Salehi I.

190. Bone-Specific markers:
Lab. tests
Bone-Specific markers:
Markers for bone resorption:
Urinary NTX & CTX: most specific
Monitoring of antiresorptive therapy for osteoporosis
Markers of bone formation:
Bone-specific Alkaline phosphatase
N-terminal propeptides of type I collagen (PINP)
Salehi I.

191. Bone-Specific markers:
Lab. tests
Bone-Specific markers:
Markers for bone resorption:
Urinary NTX & CTX: most specific
Monitoring of antiresorptive therapy for osteoporosis
Markers of bone formation:
Bone-specific Alkaline phosphatase
N-terminal propeptides of type I collagen (PINP)
Salehi I.

192. Bone-Specific markers:
Lab. tests
Bone-Specific markers:
Markers for bone resorption:
Urinary NTX & CTX: most specific
Monitoring of antiresorptive therapy for osteoporosis
Markers of bone formation:
Bone-specific Alkaline phosphatase
N-terminal propeptides of type I collagen (PINP)
Salehi I.