An ADC blood test is a study that can detect the presence of antibodies to a cyclic citrulline peptide (PCC) in the human blood. Normally, this peptide (peptides are similar in structure to proteins, but have a lower molecular weight, they can be conditionally called “lightweight” proteins) is necessary for the normal functioning of articular tissues and should not contain citrulline amino acid.
However, if atypical processes (physiological or caused by a disease) are triggered in the body, the articular membrane begins to secrete the protein CCP (containing citrulline). In response to this, human immunity perceives an atypical peptide as “pathogenic” and “attacks” it, producing special antibodies (ADCs).
So begins the autoimmune process that affects the connective tissue, mainly of small joints – rheumatoid arthritis. The test for ADC makes it possible to detect the process at an early stage – at the moment when the production of antibodies has not yet managed to lead to any articular changes.
In addition, the concentration of antibodies in the patient’s blood sample is accurately determined during the study – this indicator makes it possible to make predictions about the course of the autoimmune disorder.
A blood test for ATsP should be carried out in the presence of absolute indications, or the appearance of characteristic symptoms.
Among the latter distinguish:
- pain and swelling in small joints (feet and hands) – if these manifestations are stably present for 2 months;
- morning stiffness of movements, while the appearance and size of the joints are not changed;
- pain in the knee and elbow joints, as well as joints connecting the hand to the forearm and lower leg to foot – if the symptom does not accompany the infection.
In addition, the analysis must be taken to people whose close relatives suffer from rheumatoid arthritis. In such cases, the study should be carried out regularly throughout life.
The most reliable result will ensure the following algorithm:
- 5 days before taking the biomaterial, you should refuse to take any medications (with the exception of vital medicines).
- For 3 days, it is desirable to exclude from the menu fatty and salty foods, fried foods, sugar, alcohol.
- If possible, you should not smoke within 24 hours before analysis (in extreme cases, you should refrain from smoking for 4 hours before giving up).
- The last meal should occur 12 (optimally) or 4 hours (if blood is donated during the day) before the study.
- In the morning you can drink only water. It is better to refuse tea, coffee and juices. If blood sampling is carried out during the day, then these drinks can be excluded for 4 hours.
- For 4-6 hours before delivery, it is desirable to exclude physical activity.
Citrulline is a product of material metabolism in the body. It manifests itself in the process of biochemical reactions from an amino acid. If the body is healthy, then citrulline is not involved in protein synthesis and is excreted in full. But in the presence of rheumatoid arthritis, human blood changes its enzymatic composition.
What does a blood test for ATsP show? The value determined by the test for the recognition of rheumatoid arthritis is a specific marker of this disease. ADC is a heterogeneous grouping of antibodies that recognize the determinants of the antigens of certain proteins containing citrulline.
ADC is highly accurate – up to 98%. That is why it plays an important role in the diagnosis of arthritis, which distinguishes it from other tests for rheumatic tests. Such a study allows us to distinguish between non-erosive and erosive varieties of arthritis.
If the content of ACCP in a person is increased, then a high level of damage to the articular cartilage tissue is noted in comparison with those people in whose blood these antibodies are absent.
In medicine, this analysis is used to predict the rate of deformation of the cartilage tissue of compounds at an early stage of the disease. If a person has antibodies to CCP, then this is one of the signs of the progressive nature of the pathology.
In the aggregate, a blood test for ACCP and for a rheumatoid factor is used to diagnose the disease at the very beginning of the occurrence, prescribe the necessary treatment and prevent degenerative-dystrophic deformities in the joints.
Blood for testing is taken from a vein. To make tests, serum is required, so the blood in the first stage is processed in a centrifuge. The resulting serum must be stored for a week at a temperature of 8 ° C. A test tube is being tested. During testing, the method of scattering a laser beam in a liquid medium is used.
Joint syndrome can also be observed in a patient with various rheumatic diseases, which is a complicating factor in the analysis of rheumatic tests. In this case, the patient is prescribed an ADC test with the aim of conducting a differential diagnosis, which has increased accuracy for the establishment of arthritis – 98%, which distinguishes it from the analysis for rheumatoid factor.
The ADC test is also highly sensitive, reaching up to 70%. If you decipher it, then you can detect a pathology in the patient at the very beginning of development, if only the patient signs are found in the patient. But other types of tests for rheumatic tests determine the disease much later.
Patients who have a high antibody score have a marked course of the disease with accelerated erosion in the cartilage tissue. That is why, even at an early stage, the most effective treatment should be prescribed in order to avoid the appearance of deformations, ankyloses and other irreversible transformations in the tissues of the compounds.
So, the analysis for ATsP is notable for its high significance in the detection of arthritis in the early stages, as well as the further appointment of effective treatment.
Often you hear the question: “Where to get a blood test for ATsPs?”. In the laboratory of a regular clinic or hospital. At the same time, we recall that it means a blood test for ATsPs. This is the quantification of antibodies to a citrulline cyclic peptide.
On the day of blood donation, you must refuse to eat four hours before it. No further preparation is required from the patient. Biological material is taken from a vein, then centrifuged, and the plasma obtained as a result is analyzed for the presence of ADC in it.
The test for ATsP – analysis for the presence of cyclic citrulline peptide antibodies in the blood serum – is a modern research method that allows the diagnosis of rheumatoid arthritis (RA) of joints at an early stage of the pathology. Antigens of the PCP begin to be produced one and a half years before the first signs of rheumatoid arthritis appear, while the appearance of the rheumatoid factor already indicates the onset of the inflammatory process.
Citrulline is a natural metabolic product produced during the biochemical reaction from an amino acid.
The substance is excreted from the body of a healthy person almost completely, and those microscopic doses that are present in the blood are not able to have a significant effect on the process of protein synthesis.
But the occurrence of rheumatoid arthritis leads to changes in the enzymatic composition of the blood and an increase in the level of citrulline.
The peptide (protein molecule) containing citrulline is perceived by the body as a foreign element, and the immune system, seeking to protect itself, begins to produce specific antibodies aimed at combating it. The rate of ADC in rheumatoid arthritis is significantly increased. This allows us to consider the indicator of the level of ADC as a marker of rheumatoid arthritis.
A blood sample is taken from a vein. The following restrictions are recommended to the patient 12 hours before analysis:
- Do not take any food;
- Do not drink anything, including water;
- Do not smoke.
Compliance with these restrictions is very important. Otherwise, it is impossible to guarantee the accuracy of the result, since the composition of the blood will be changed.
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- Tasks and objectives of the samples
- Causes and Symptoms of Rheumatoid Arthritis
- What is it for?
- Instrumental diagnostic methods
- General blood analysis
- Indications for ADC analysis
- ESR (erythrocyte sedimentation rate)
- Analysis procedure
- C-reactive protein assay
- ATsP at rheumatoid arthritis: interpretation of the analysis, norm and price
- Rate indicator
- Advantages of the method
- Inaccuracies analysis
- Anticytrulline antibodies
- Where can I get an analysis
- What is the purpose of the analysis?
Tasks and objectives of the samples
The ADC test is one of the most modern and accurate methods for diagnosing RA. A blood test allows you to:
- To detect arthritis at the stage of the disease, when no more than 6 months have passed since the onset of the pathology;
- Diagnose RA at an early stage, when the duration of the disease is from 6 months to 1 year;
- Determine the seronegative type of disease in which there are no manifestations of a rheumatoid factor;
- Differentiate this type of arthropathy from other forms of articular pathologies that have similar symptoms;
- Predict the risk of articular deformities in the early stages of rheumatoid arthritis;
- Monitor the progress of the disease and make the necessary adjustments to the course of treatment.
The analysis gives a high percentage of RA recognition – up to 98%. Its sensitivity to RA is about 70%. Only a test for ADC allows you to detect RA long before the manifestations of specific symptoms.
An early diagnosis allows you to take timely measures to prevent the progression of this form of arthopathology. And also to prevent the development of degenerative-destructive processes in the periarticular, cartilage and bone tissues. Timely initiation of treatment significantly reduces the likelihood of poor prognosis for patients with RA.
Indicators in the analysis of ADC
The results of the tests show whether a person has rheumatoid arthropathy. Deciphering the results of the analysis on ADC for rheumatoid arthritis helps to determine the stage of development and the severity of the disease.
Normally, the test indicators are the same for representatives of both sexes in any age categories, which is rare in medicine: in men, women and children, they range from 0 to 3 – 3,1 U/ml. But slight differences in the norm are still possible:
- In pregnant women, the indicator varies from 3,8 to 4 units/ml;
- In elderly patients, an increase in the norm to 2 U/ml is possible;
- In young children with an unformed skeleton, the norm is 2,7 – 2,8 U/ml.
Causes and Symptoms of Rheumatoid Arthritis
A laboratory test for rheumatoid factor is a screening study aimed at identifying autoimmune disorders. The main objective of the study on the rheumatoid factor is the identification of rheumatoid arthritis, Sjögren’s disease and syndrome, and a number of other autoimmune diseases.
A rheumatoid factor test may be required for the following symptoms:
- joint pain and swelling;
- limited mobility in the joints;
- a feeling of dryness in the eyes and mouth;
- skin rashes by type of hemorrhage;
- weakness, breakdown.
Theoretically, there should not be a rheumatoid factor in a healthy body. But still, in the blood of some even healthy people, this factor is present in a small titer. Depending on the laboratory, the upper limit of the norm of the rheumatoid factor varies from 10 to 25 international units (IU) per 1 milliliter of blood.
Rheumatoid factor is the same in women and men. In elderly people, the rheumatoid factor will be slightly higher.
The rheumatoid factor in a child should be normal 12,5 IU per milliliter.
If the cause of the increased rheumatoid factor is infectious diseases, for example, infectious mononucleosis, then the titer of the rheumatoid factor is usually less than with rheumatoid arthritis.
However, rheumatoid factor analysis primarily helps to recognize rheumatoid arthritis. However, it should be emphasized that it is impossible to make a diagnosis only on its basis. Since the rheumatoid factor can be increased in many other pathological conditions of an autoimmune and non-autoimmune nature.
A blood test for rheumatoid factor is carried out in the morning on an empty stomach (from the last meal should take from 8 to 12 hours).
Pathological changes in the joints worry not only the elderly, but also more and more young patients. Most often, disorders in the condition of the joints are characterized by a severe course and require complex long-term treatment.
So, the norm of ACCP for rheumatoid arthritis or its deviation in the results of the analysis, will be able to recognize this disease at an early stage, when obvious signs and symptoms do not yet manifest themselves.
Rheumatoid arthritis, or RA for short, is a disease with serious joint damage that can be detected at any age.
A characteristic feature of it is the processes affecting the synovial articular membrane and causing its inflammation, as well as leading to the destruction of cartilage articular tissues with its deformation.
The disease is very dangerous and threatens with serious complications, and only timely treatment on the basis of the diagnosis can save the situation.
The ADC test is a determination of the concentration of antibodies to a citrulline cyclic peptide of a specific organism. Thanks to this diagnostic method, it became possible to detect destructive processes in the joints, regardless of their stage of development.
With the help of the ADC test, the presence of markers and antibodies that appeared there during the development of rheumatoid arthritis is easily detected in the blood.
What is it for?
With advanced cases of rheumatoid arthritis, severe complications develop with partial and even complete loss of motor capabilities of the joints, most often ending in disability.
Therefore, timely diagnosis using the analysis of ADCs is of great importance for maintaining health.
The opportunity to make the right diagnosis of arthritis of this form in time will allow you to start the correct and effective therapy at an early stage of the disease, when the damage to the joint is not very significant and with the help of drugs you can maintain its function.
Detection of citrulline, formed from angin in the course of biochemical reactions, indicates damage to the joints with a rheumatoid form of arthritis. Citruline is integrated into the protein chain of the amino acid and affects the function of the cartilage tissues of the joint.
The immune system perceives the peptide containing citrulline as a foreign element and begins to produce antibodies to protect against a threatening state.
The importance of ADC is the accuracy in identifying various types of arthritis; other diseases cannot be detected with this test.
Despite the fact that such a study requires scrupulousness and accuracy in conducting, however, it is one of the most accurate diagnostics that can identify a pathology at its early stage, as well as determine the degree of its development and characteristic features.
The ADC test has a number of advantages over similar studies, namely:
- a high degree of detection of the presence of antibodies to ADC in the early stage without the presence of complications and before the development of severe symptoms;
- the ability to analyze the course of the disease;
- analysis accuracy of up to one hundred percent.
Doctors prescribe the ADC method for patients who have the very initial signs of rheumatoid arthritis, thereby saving their joints from complete destruction. According to the indicators of this study, you can accurately determine the form of existing arthritis, as well as the nature of its further course.
Examination using a PCP test for antibodies in the blood should be done as early as possible, without waiting for the moment when the inflammatory process begins to destroy the joints. The following manifestations may indicate the need for testing:
- the appearance of a crunch and pain in the joint during movement;
- joint pain worse at night;
- swelling of the tissues surrounding the joint;
- symptoms of local inflammation in the form of redness with an increase in skin temperature;
- impaired mobility of the affected joint, especially pronounced in the morning, after waking up.
In patients with rheumatoid arthritis, common signs of the disease can be detected in the form of fatigue, daytime drowsiness, decreased appetite and weakness.
Preparation for the analysis of the ADC is not particularly difficult, however, some rules still need to adhere. For this:
- the last meal should be no later than 8 hours before the test;
- during the day, the use of any liqu >
A feature of the analysis of ADC in rheumatoid arthritis is its carrying out on an empty stomach, only in this case you can get the most accurate results.
The ATsP test determines and shows a violation in the composition of enzymes that occurs as a result of an inflammatory reaction. According to the results of the study, a deviation in the formation of antibodies is detected in the form of a significant excess of their norm.
This blood test is a modern laboratory study, which reveals the ratio of antibodies to cyclic citrulinated peptide. Today, this analysis allows with great accuracy to detect the onset of rheumatoid arthritis.
Such an opportunity is given due to the early formation of ATsPs in the blood, usually a year or a half before the onset of signs of the disease. Compared with it, other diagnostic methods with a similar task, detect the symptoms of the disease much later.
Examination by a similar method distinguishes the non-erosive form of arthritis from its erosive form. With elevated levels of ADC, significant damage to cartilage tissue is usually noted when compared with patients with no such antibodies in their blood.
Detection of antibodies to CCP is a symptom of the active development of pathological changes in the joints and the progressive nature of the disease.
The purpose of the analysis for ACCP is to identify rheumatoid arthritis, to prescribe the treatment necessary for this disease and to prevent the development of degenerative deformation of the affected joint.
According to the indicators obtained as a result of the analysis, doctors give an assessment of the severity of the ongoing disease and the approximate stage of its development.
One of the features of the test is the absence of differences in the normal indicator, depending on the age of the patient. The norm of analysis in people of different ages is considered to be a value from 3 to 3.
1 Unit/ml, and only in exceptional cases, it may differ slightly.
- in young children – up to 2.7 U/ml;
- in women during pregnancy – from 3.8 to 4.0 U/ml;
- in elderly people – up to 2 units/ml.
An increase in the rate of ADC is one of the signs of rheumatoid arthritis. With a directly proportional increase in the index, arthritis joins articular inflammatory processes. It is noteworthy that the performance of the ADC does not decrease even after the patient’s condition improves, therefore testing does not allow to track the effectiveness of the therapy.
Based on the results obtained during the study, the doctor prescribes complex therapy. The effectiveness of treatment can be judged by a decrease in the number of antibodies in the studied blood samples.
ADC is decoded in the presence of rheumatoid arthritis based on the following values:
- negative indicators – from 0 to 20 Edml;
- weakly positive – from 20.0 to 39.0 edm;
- positive – from 40.0 to 59.9 edm;
- expressed positive – more than 60 Edml.
Although the normal values of ADC are up to 20.0 Edml, however, many doctors consider the complete exclusion of rheumatoid arthritis to be only zero values indicating the complete absence of this type of antibody in the blood of the examined patient.
The material for the study of ADC is blood taken from a vein. The testing procedure itself is as follows:
- Blood is taken in the usual way in the morning;
- Tubes with selected material can be stored in the clinic under special conditions for up to a week.
- A study of blood serum.
- Based on the result, a description is made of it.
- After which the result of the test is issued to the patient.
- hormonal disorders;
- hypothermia of the joints;
- infectious processes;
- transferred t equal;
- stressful situations (a common cause of the disease in women).
- general blood test (mandatory ESR);
- general urinalysis;
- blood biochemistry (ALT, AST, C-reactive protein, creatinine);
- and screening for anticytrulline antibodies and rheumatoid factor;
- hepatitis markers;
- analysis for antinuclear antibodies.
- At the level of liver enzymes AST, ALT. They cannot testify about the presence of inflammation, but before treating rheumatoid arthritis of the arms and legs, the doctor must evaluate the condition of the liver and select the optimal therapy.
- Creatinine. It is excreted by the kidneys as the final product of protein metabolism. With increased rates, one can judge about the poor functioning of the kidneys. Toxic drugs in this case will be unacceptable for use.
- Protein fractions. This non-specific indicator confirms the presence of an inflammatory process in the body.
- serous rheumatoid arthritis (ICD code 10 – M 05.8);
- Hard currency;
- with cleroderma;
- availability of tumors;
- n arasitic and infectious diseases;
- in asculitis.
Instrumental diagnostic methods
The main symptom of the pathology is damage to the articular tissues. With its development, a person has symptoms such as:
- tissue swelling;
- joint pain;
- ep >
As the pathology develops, joint inflammation also progresses, which ultimately limits movement and contributes to the development of negative changes.
In the early stages of pathology, differential diagnosis is necessary. The specialist should carefully analyze the typical signs of arthritis, articular inflammatory lesions, rheumatoid factor, and the presence of PCP antibodies.
- Rheumatology: textbook/Ed. prof. N.A. Shostak. // M.: GEOTAR-Media, 2012.
- Why is early diagnosis and treatment of rheumatoid arthritis necessary? /. Nasonov E.L. // breast cancer, 2002.
- Rheumatoid arthritis./Karateev D.E.// NP “Equal right to life”, 2014.
- Diagnosis of rheumatic diseases/Reutsky I.A., Marinin V.F., Glotov A.V. // MIA, 2011.
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Arthroscopy Minimally invasive surgical method. Two small punctures in the knee are made, a camera is introduced, thanks to which it is possible to diagnose all internal changes. The information obtained makes it possible to plan the right treatment.
Biopsy. The procedure is performed under anesthesia using arthroscopic access. For research, a fence of synovial tissue is made. The nature of the lesions is examined by microscopic and histological methods.
Joint scintigraphy. The most informative method. Used radiation diagnostics. Already in the early stages, problems are identified. The study is carried out on a gamma-ray tomograph.
MRI The method is very sensitive, makes it possible to identify edema, bone erosion, synovitis. But to confirm the diagnosis, additional studies will be required, since these signs may not always belong to this ailment.
Ultrasound of the joints. Non-traumatic, economical, affordable method. Superior in accuracy to radiological. It is possible to visualize the condition of cartilage, tendons, ligaments.
Roentgenography. To adjust treatment, this method is used to monitor changes in the development of bone erosion. In the early stages of rheumatoid arthritis, an x-ray helps detect problems only on the feet and hands. Examination does not provide an opportunity to detect the symmetry of developing processes in rheumatoid arthritis.
ADCP (blood test) is a study that can be called the “gold standard” in identifying rheumatoid arthritis. ATsPs actively competes with more “old” type of diagnostics – a rheumatoid factor.
Benefits of ADC blood test.
|Test Evaluation Criteria||Decryption criteria for the analysis of ADC||Advantages and disadvantages|
|Sensitivity – the ability of a sample to detect a disease.||Estimated based on the number of false negative results, averaging 70%|
|Early sensitivity||For ATsP, this indicator is 50% in the first 6 months, rheumatic factor is detected in 35% of patients in the first 12 months|
|Specificity||It is estimated based on how often antibodies are found in people with rheumatoid arthritis. For ADC, the indicator reaches 98%|
|The likelihood of a negative test in the presence of rheumatoid arthritis||In 15% of people with rheumatoid arthritis, ACCP can deny the disease throughout life or occur later. For rheumatoid factor, this value exceeds 50%|
|Probability of positive ADC in the absence of rheumatoid arthritis||False positive analysis of ADC can take place only with systemic lupus erythematosus (according to official studies). False positive rheumatic factor occurs in 40% of people, 5% of whom are completely healthy|
|The ability to assess the dynamics of the disease||The increase in the concentration of ADC can serve to assess the progress of the disease or the effectiveness of treatment. A change in the numerical value of the rheumatoid factor has no clinical significance|
|Survey speed||The result of the analysis for antibodies to PCP can be obtained after 2-3 days. A blood sample for the rheumatic factor will take 1-2 days|
|Cost||Examination is about 3 times more expensive than rheumatic factor||—|
|Availability||The analysis can be carried out in private diagnostic laboratories. State clinics, as a rule, do not conduct it||—|
It is the last two circumstances (availability and cost) that explain the predominance in the diagnosis of analysis for rheumatoid factor.
General blood analysis
For clarity, we will give a transcript of a blood test normal for rheumatoid arthritis.
|ESR||3-15 mm/h||gt; 23 mm/h|
|Red blood cell count||3,5–5,0 * 10 12/l||lt; 3,5 * 10 12/l|
|White blood cell count||4,0–10,0 * 10 9/l||15,0–20,0 * 10 9/L|
|Hemoglobin||120–180 g/l||lt; 110 g/l|
When studying a blood test, it is necessary to consider that the growth of ESR occurs not only with rheumatoid arthritis. Violation of sedimentation (sedimentation) of red blood cells can be observed with other ailments. Therefore, if only ESR has grown, you can not worry. It is worse when, in combination with the rapid sedimentation of red blood cells, the patient develops symptoms of joint inflammation.
With rheumatoid arthritis, special attention in the blood test should be paid to the level of lymphocytes. In healthy people, their value does not exceed 35%, and with multiple damage to the joints, it shifts upward. For the purity and reliability of the results of the analysis, the patient should not take medications that cause lymphocytosis (narcotic analgesics, Phenytoin, Levadopu).
From a general analysis of urine, one can learn about the presence of bacterial cells, biochemical substrates, and general physical and chemical properties. When establishing rheumatoid arthritis, doctors are most interested in the following indications:
- The presence of inflammatory bacterial signs in the blood is elevated leukocytes, changes in the leukocyte formula. These indicators increase with infections, with autoimmune pathologies rarely change.
- The presence of viral inflammation is a decrease in white blood cells and an increase in lymphocytes. This picture is observed with reactive inflammation of the joints, which is caused by hepatitis viruses.
- Elevated protein in the urine and the presence of white blood cells indicate the presence of an inflammatory process. In rheumatoid arthritis, this pattern is characteristic.
In general, studies of only urine and blood are extremely uninformative. For proper diagnosis, especially in cases when disability is established with rheumatoid arthritis, it is simply necessary to undergo a comprehensive examination.
General blood and urine tests make it possible to exclude other diseases.
Indications for ADC analysis
An ADCP blood test is a study that is not prescribed without objective reasons.
Among the absolute indications for the test:
- inflammation of the joints of the hands in the absence of irregularities in the x-ray;
- detection during x-ray examination of cysts in the periarticular zones;
- the need to predict the risk of rheumatoid arthritis 1-2 years before the onset of the onset of symptoms – subject to a hereditary predisposition;
- the assumption of the presence of rheumatoid arthritis is made on the basis of the results of other biochemical tests (in particular, rheumatoid factor);
- assessment of the presence of antibodies at the early (up to 6 months) and first (from 6 months to 1 year) stage of the disease;
- identification of the seronegative form of arthritis – a variety in which symptoms are present and the rheumatoid factor denies the disease;
- differentiation of rheumatoid arthritis from diseases similar in clinical signs;
- determination of the dynamics of the joint destruction process – carried out on the basis of a quantitative assessment of the concentration of antibodies;
- assessment of the effectiveness of therapy prescribed to the patient – with a previously established diagnosis;
- the presence of diseases accompanied by damage to the connective tissue in close relatives;
- clinically identified genetic predisposition to autoimmune disorders.
ACCP is invaluable in the treatment of rheumatoid arthritis – the test (this is one of the key differences between ACCP and the rheumatic factor) makes it possible to predict more aggressive rates of the disease and, accordingly, to adjust treatment in advance.
ESR (erythrocyte sedimentation rate)
Particular attention is paid to the analysis of blood erythrocyte sedimentation rate (ESR). The principle of this study is described below.
Blood is a rather complex medium. In addition to water and cellular elements, it contains various biochemical substrates, including protein.
If the test tube with blood is left motionless, alone, then the red blood cells begin to settle due to gravity.
The rate of such subsidence largely depends on how individual red blood cells combine into aggregates.
The latter can occur due to high protein, which causes inflammatory reactions.
If ESR is increased, then it can be argued that there are inflammatory processes that occur with rheumatoid arthritis. The hands and feet of patients begin to whine in such cases, respond to the weather, and pains appear.
ESR makes it possible to determine the activity of the disease, indicators indicate autoimmune active processes. During treatment, the doctor’s task is to reduce the ESR to a normal level, this fact will confirm the correctness of the chosen therapy.
The material for the study is venous blood. To obtain serum, the biomaterial is processed in a centrifuge.
To detect the concentration of antibodies, 3 methods are used:
- immunofluorescence – processing of the desired antibodies with a fluorescent substance, followed by studying a serum sample under a microscope;
- chemiluminescent – highlighting of antibodies under the influence of chemical compounds;
- enzyme-linked immunosorbent assay using tests of the 2nd generation – it is considered preferable, it is distinguished by the ease of registration and stability of the enzyme-desired antibody compounds. It allows for both qualitative (antibodies present/absent) and quantitative analysis.
The results of a non-urgent test can be obtained in 1-3 days, an urgent test – a few hours after taking the biomaterial.
C-reactive protein assay
To determine in the analysis of CRP, the doctor must make a special mark in the direction. Why is the indicator determined? In the acute phase of inflammation, C-reactive protein is the most important. Without this metabolite, our immune system could not respond to damaging factors by inflammatory processes. If the indicator exceeds the norm, this indicates an inflammatory process in the body, which has an unknown location, the nature may be viral, bacterial, autoimmune. Elevated CRP indicates a systemic pathology in the body.
C-reactive protein (CRP) is a very sensitive element in a blood test that quickly responds to even the smallest damage to body tissue. The presence of C-reactive protein in the blood is a harbinger of inflammation, trauma, penetration of bacteria, fungi, and parasites into the body.
CRP more accurately shows the inflammatory process in the body than ESR (erythrocyte sedimentation rate). At the same time, C-reactive protein quickly appears and disappears – faster than ESR changes.
For the ability of C-reactive protein in the blood to appear at the very peak of the disease, it is also called the “acute phase protein”.
With the transition of the disease to the chronic phase, C-reactive protein decreases in the blood, and with an exacerbation of the process rises again.
C-reactive protein is produced by liver cells and is contained in a minimum amount in blood serum. The content of CRP in serum does not depend on hormones, pregnancy, gender, age.
The norm of C-reactive protein in adults and children is the same – less than 5 mg/l (or 0,5 mg/dl).
A blood test for C-reactive protein is taken from a vein in the morning on an empty stomach.
With the slightest inflammation in the first 6-8 hours, the concentration of C-reactive protein in the blood rises tenfold. There is a direct correlation between the severity of the disease and changes in the level of CRP. Those. the higher the concentration of C-reactive protein, the stronger the inflammatory process develops.
Therefore, a change in the concentration of C-reactive protein is used to monitor and control the effectiveness of the treatment of bacterial and viral infections.
- The presence of chronic bacterial infections and some systemic rheumatic diseases increases C-reactive protein to 10-30 mg/l. With a viral infection (if there is no injury), the level of CRP increases slightly. Therefore, its high values indicate the presence of a bacterial infection.
- If neonatal sepsis is suspected, a CRP level of 12 mg/L or more indicates the need for urgent antimicrobial therapy.
- In acute bacterial infections, an exacerbation of certain chronic diseases, acute myocardial infarction and after surgery, the highest level of CRP is from 40 to 100 mg/l. With proper treatment, the concentration of C-reactive protein decreases in the coming days, and if this does not happen, it is necessary to discuss another antibacterial treatment. If after 4-6 days of treatment the CRP value has not decreased, but remained the same and even increased, this indicates the appearance of complications (pneumonia, thrombophlebitis, wound abscess, etc.). After surgery, CRP will be higher, the heavier the operation.
- With myocardial infarction, the protein rises 18-36 hours after the onset of the disease, decreases after 18-20 days and comes to normal by 30-40 days. With angina pectoris, he remains normal.
- In various tumors, an increase in the level of C-reactive protein can serve as a test to assess the progression of tumors and relapse of the disease.
- Severe general infections, burns, sepsis increase C-reactive protein to enormous values: up to 300 mg/l or more.
- With proper treatment, the level of C-reactive protein decreases by 6-10 days.
In order for the analyzes to show objective information, it is necessary to adhere to some rules. You need to donate blood in the morning, on an empty stomach. Approximately 12 hours should elapse between taking tests and eating. If thirsty, drink some water, but not juice, tea, or coffee. It is necessary to exclude intense exercise, stress. Do not smoke or drink alcohol.
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ATsP at rheumatoid arthritis: interpretation of the analysis, norm and price
The cyclic citrulline peptide is involved in the maintenance of the normal state of articular tissues. If the immune system is disturbed, this substance is perceived as a pathogenic, pathological element for the body, and specific antibodies are produced against it.
By their presence, the presence of the disease is determined. Antibodies can be detected as soon as they are developed, even before the joints are seriously affected by the damaging effects of rheumatoid arthritis.
Thus, it is possible to determine the presence of the disease already at the stage of the latent course, when clinical symptoms are completely absent.
There are certain indications for the study, which the doctor relies on when prescribing the analysis. This study is conducted with the following objectives:
- definition of the disease at an early stage when it develops for less than 6 months;
- detection of the disease at the first stage, which is determined from 6 months after the onset of pathology to a year;
- determination of a seronegative form of pathology when the rheumatoid factor in the blood is not detected;
- differentiation of the disorder from other forms of arthritis and other joint pathologies;
- determining the likelihood of developing joint deformities already at the initial stage of the disease is necessary to build the right therapeutic tactics.
If the patient has a predisposition to the development of rheumatoid arthritis, then he is advised to regularly take an analysis to timely determine the onset of the disease if a pathology occurs. It may not appear throughout life, but, nevertheless, control is necessary.
The norm in women and men in the indicator of ADC is the same. It varies solely with age.
|3,8-4 U/ml||From 2 units/ml||2,7 U/ml|
If the indicator is above normal, then this indicates a violation in the functioning of the immune system and the development of the pathological process.
|Up to 5 units/ml||From 5 to 10 units/ml||From 10 to 17 units/ml||From 17 units/ml|
Despite the fact that if the indicator is up to 5 U/ml, the result of the analysis is considered negative, most doctors believe that if the ATsP exceeds the generally accepted level, then the person should be included in the risk group and regularly give blood for analysis. This in the case of the development of the disease will allow to identify it as early as possible.
The analysis today is recognized as the most effective and accurate means of diagnosing RA.
Advantages of the method
For analysis, blood serum is used, in which antibodies and their quantity are determined. Venous blood is taken for research. The advantages of this diagnostic method are:
- the ability to accurately determine the pathology at the onset of the disease until the first signs of joint destruction appear in 85% of cases;
- accurate identification of the degree and speed of disease progression in 85% of cases;
- the reliability of the data obtained is 98%;
- the ability to determine in which direction the progression of the disease will occur, and on the basis of these data to build treatment tactics to prevent the rapid development of disability in the patient;
- low cost of analysis in comparison with other diagnostic methods for the detection of rheumatoid arthritis.
This study is recommended for patients in all cases where there is a risk of developing autoimmune joint disease.
To decipher the results, it is necessary to determine the amount of immunoglobulins G contained in it that bind to a citrulline cyclic peptide:
- up to 20 units – the test is negative;
- from 20 to 39,9 – the test is slightly positive;
- from 40 to 59,9 – a positive test;
- more than 60 – the text is expressed positive.
Some experts are inclined to believe that the value lying within 20 Units in the framework of this study is normal, and if such a result is obtained, then it is regarded as an error. But the predominant number of specialists believes that the norm of analysis is the complete absence of ADC in the patient’s blood.
Thanks to the decoding of the parameters of a blood test for ATsPs (what we explained), it is possible not only to determine the diagnosis, but also to monitor the effectiveness of the therapeutic course. If the amount of antibodies in further analyzes decreases, then this indicates that the dose of the drug was selected correctly, which means that there is a positive trend in treatment.
Normal values or intervals will depend on the laboratory, the equipment used, and the serum test method.
If an immunofluorescence technique is used, the following values may appear in the results form:
- less than 3 u/ml – a “negative” result;
- less than 5 u/ml – “weakly positive” result;
- 5 u/ml or more – further studies are needed.
If the analysis is performed using chemiluminescence, the threshold value will be 17 u/ml.
When using enzyme-linked immunosorbent assay (“gold standard” when detecting ADC), you can focus on such reference indicators:
- up to 30 RU/ml – antibodies are not detected, “negative” result;
- from 30 to 90 RU/ml – the concentration of antibodies is small, a “weakly positive” result. In this case, it makes sense to repeat the study in a month;
- more than 90 RU/ml – significant concentrations of antibodies, a “positive” result.
The results of the analysis can not independently serve for the diagnosis. You can talk about the presence/absence of the disease based on the general picture, including symptoms, data on heredity and other studies.
|Analysis results||symptomatology||Other studies (rheumatoid factor, spondylitis marker)||Forecast|
|Negative||No||Not crucial||The risk of developing the disease is small, but if the process begins, it will proceed in a mild form|
|Positive||Present||Rheumatoid factor can be either positive or negative.||The development of the disease is likely, or it proceeds at an early stage|
|Positive, high antibody concentration||Present, corresponds to the clinic of rheumatoid arthritis||Rheumatoid factor positive||The process is developing rapidly, the appearance of severe symptoms is possible|
The table shows only general cases. In real life, the symptoms, the presence of genetically determined diseases, including joint diseases, are objectively assessed (for example, ankylosing spondylitis – ankylosing spondylitis, in which the joints of the sacrum and spine are destroyed).
An ADC blood test may not be the only study to diagnose rheumatoid arthritis. The sensitivity and specificity of the test is not 100%.
In this case, among the inaccuracies, one can distinguish the following patterns:
- sensitivity (the reciprocal of the number of false negative results) increases as the disease progresses. The longer the process takes, the greater the likelihood that the study will detect antibodies;
- ADC may not be detected with actively occurring rheumatoid arthritis – this situation occurs in 15% of patients. Of these, it is detected later in some, while in others it is not detected at all. Often this is due to the presence of concomitant inflammation of the vessels or bones;
- the result can be false positive (confirmed by clinical studies) with systemic lupus erythematosus – in rare cases.
There is evidence of false positive results of the test for ATsPP in people suffering from:
- impaired liver function, including cirrhosis;
- oncological diseases;
- severe tuberculosis.
One of the most reliable tests used in the diagnosis of RA is antinuclear antibody screening (ANAs). Analysis for rheumatoid arthritis of the joints is carried out in 3 ways:
- ELISA – enzyme-linked immunosorbent assay;
- RNIF – a set of immunological tests;
- immunoblot – an additional indirect analysis of antinuclear antibodies.
Simultaneously with the identification of antinuclear factors, the amount of antibodies, especially the IgM type, is evaluated. The detection of these markers in the blood indicates a high risk of arthritis.
In healthy people, antinuclear antibodies are absent in the analysis or are at a minimum concentration. The ANAs norm for the ELISA method is given in the table.
|lt; 0,9 units||negative|
|gt; 1,1 units||positive|
For RNIF screening, the normal value will be titer lt; 1: 160. The immunoblot should show “0”.
When deciphering a blood test for antinuclear antibodies, it is important to remember that a negative screening result is not a guarantee of the absence of arthritis in patients with characteristic symptoms.
Laboratory diagnosis of rheumatoid arthritis makes it possible to detect anti-citrulline antibodies (ADCs) in the blood. Citrulline is an amino acid that is part of a protein. The latter is part of the connective and epithelial tissue. If antibodies to this amino acid are produced, damage to the joint capsules in the joints can be judged.
But trusting only this indicator is not worth it, since there are cases of increasing ADCP in other systemic diseases.
If some autoimmune processes occur in the body, the production of a certain amount of anti-protein antibodies in the body begins. These antibodies are called antinuclear. It is recommended to determine this indicator if the analysis revealed inflammations of an unclear nature. For example, with increased ESR.
However, antinuclear antibodies are not a highly specific marker in the diagnosis of rheumatoid arthritis. This indicator can also be detected with:
- systemic diseases of the connective tissue;
- reactive arthritis.
Using the ANA test, it is possible to determine the presence of antinuclear antibodies (antibodies to nuclear antigens) in the blood.
ANA is a group of specific autoantibodies that the immune system of our body produces in the event of autoimmune disorders. Antibodies have a damaging effect on body cells. At the same time, a person experiences various painful symptoms, such as pain in muscles and joints, general weakness, etc.
Detection of antibodies belonging to the AHA group in the blood serum (for example, antibodies to double-stranded DNA) helps to identify an autoimmune disease, to control the course of the disease and the effectiveness of its treatment.
Blood for antinuclear antibodies is taken from an elbow vein on an empty stomach. Before the study, you can not adhere to any diet.
In some cases, in order to differentiate various autoimmune diseases, additional specifying tests for autoantibodies from the group of antinuclear antibodies, the so-called ANA immunoblot, may be required.
Antinuclear antibodies (another name is the antinuclear factor) indicate the presence of some kind of autoimmune disorder, but do not indicate exactly the disease that caused it, since the ANA test is a screening study. The purpose of any screening is to identify people with an increased risk of a particular disease.
A healthy person with normal immunity should not have antinuclear antibodies in the blood or their level should not exceed the established reference values.
The normal ANA value implies an antibody titer not exceeding a value of 1: 160. Below this value, the analysis is considered negative.
A positive analysis for antinuclear antibodies (1: 320 or more) indicates an increase in antinuclear antibodies, and the presence of a human autoimmune disease.
Currently, two methods are used to detect antinuclear antibodies: an indirect immunofluorescence reaction using the so-called Hep2 cell line and an enzyme-linked immunosorbent assay. Both tests complement each other, and therefore they are recommended to be performed simultaneously.
In case of a positive analysis for antinuclear antibodies, it is necessary to carry out an immunoblot of antinuclear antibodies to clarify the type of autoimmune disease and make a diagnosis.
Where can I get an analysis
A blood test for ATsPs can be taken in private clinics or large laboratories with branches throughout Russia. When choosing a medical institution, one should pay attention not only to the cost, but also to the method for determining antibodies. Equally important is the presence of a wide range of tests performed by the laboratory – this indicates the availability of the necessary equipment.
The average cost of analysis is from 1000 to 1500 rubles. In a prestigious clinic, the price can reach 3000 rubles. If urgent analysis is required, the cost increases.
What is the purpose of the analysis?
If the analysis for ADCP and other studies (ESR of the blood, rheumatic factor) confirm the presence of the disease, and also there are symptoms, then the diagnosis of rheumatoid arthritis is made in one of 4 classes. The class depends on how well the patient is working. Methods to cure the disease completely do not exist today.
Combined therapy will be aimed at:
- elimination of symptoms;
- prevention of deforming changes in the joints;
- normalization of mobility of articular joints;
- increase in periods of remission (weakening of the manifestations of the disease);
- improving quality and increasing the life expectancy of the patient.
Treatment involves 4 directions:
- taking medication is the basis of therapeutic tactics;
- therapeutic exercises – individually selected sets of exercises are used;
- physiotherapy (magnetotherapy, ultrasound, electrophoresis) – are used to: relieve inflammation, swelling and pain; normalization of blood circulation in the joints; stimulation of tissue repair; increasing the effectiveness of medications;
- traditional medicine – after consulting a doctor, he is able to successfully supplement traditional therapy.
Drug therapy involves 2 directions. Basic antirheumatic drugs – affect the course of the underlying disease.
The groups of medicines include:
- immunosuppressants (Methotrexate, Cyclophosphamide, Leflunomide) – suppress immunity, the “incorrect” work of which causes inflammation. The drugs are highly effective, reduce the need for painkillers;
- sulfonamides (salazopyridosine, sulfasalazine) – weaken the symptoms of the disease, reduce the production of antibodies. The drugs are well tolerated, give results after a long time – from 3 months to 1 year;
- aminoquinoline (antimalarial) drugs (Rezokhin, Hydroxychloroquine) – suppress immunity and relieve inflammation in autoimmune diseases;
- gold salts (Aurothiomalate, Auronofin) – inhibit erosive changes in the joints and reduce the concentration of antibodies. In addition, the drug has a restorative effect. Medications have a number of specific side effects;
- genetically modified drugs (Embrel, Orentia, Rituxan, Humira) – change the immune response, selectively acting on the desired enzymes. The disadvantages are the increased likelihood of secondary infection and exacerbation of chronic disorders. Biological agents are conditionally referred to as basic therapy, more often they are used for the ineffectiveness of immunosuppressants and sulfonamides. Their use helps to reduce the risk of cardiovascular disorders accompanying rheumatoid arthritis.
Means of symptomatic therapy – drugs that eliminate pain and inflammation, without affecting the underlying disease. Among the groups of medicines: non-steroidal anti-inflammatory drugs – NSAIDs (Ibuprofen, Indomethacin, Ketanov) and glucocorticosteroids (Prednisolone, Dexamethasone). Glucocorticosteroids have more side effects, but they can instantly relieve severe pain.
In this case, the optimal treatment selection period should not exceed six months. A patient who is prescribed a treatment regimen should carefully monitor the condition of the joints and the body as a whole, monitoring all changes and possible side effects.
Among the popular folk remedies:
- potatoes with kefir. A small tuber should be grated and filled with kefir (100 ml). It should be taken in the morning, before meals 10 days in a row, then 10 days a day, then 10 days after 2 days. For each intake, the mixture must be prepared a new mixture;
- buttercup flowers. 30 pieces should be ground with a pestle. When the flowers give the juice, you will need to put the mass on a layer of gauze, and then attach it to the diseased joint. Compress duration – from 2 hours;
- a mixture of radish juice, honey and alcohol. 200-300 ml (about 1,5 cups) of black radish juice, 70 ml of honey (incomplete cup) and 50 ml of vodka should be mixed until a homogeneous mass is obtained. It is necessary to apply the product locally, rubbing the affected joint from 3 times a day.
The treatment of rheumatoid arthritis is a long process that requires patience, observation by a rheumatologist and adherence to medication regimens and physiotherapy courses. The ATsP-analysis of blood today is a highly specific marker of the development of the disease.
The implementation of such a study allows us to predict the development of the disease in 1-2 years, as well as to identify the disease at an early stage when there are no changes in the tissues of the joints.
In addition, the analysis can be used during treatment – for an objective assessment of the correctness of the selection of basic drugs. The marker of ATsP gives the chance to appoint therapy, allowing to increase duration and to improve quality of life of the patient.
The appointment of a blood test for ATsPP has the following objectives:
- identification of rheumatoid arthritis at its initial stage (less than six months);
- detection of pathology in the early stages, that is, from six months to one year;
- identification of seronegative disease forms when the rheumatoid factor is negative;
- differentiation of arthritis and other diseases that are associated with joint damage;
- assessment of the risk of joint deformities in the patient (in the early stages of pathology);
- the appointment of the most effective therapy in this case.