The 5 commonly used rheumatism indicators represent very different meanings!

*Only for medical professionals to read the reference article to understand the meaning and analysis of the main rheumatism indicators.

For a long time, due to the different causes of rheumatism, various diseases, and complex conditions, there are many different autoantibodies in the blood of patients, so laboratory examinations occupy an important position in the diagnosis of rheumatism.

In addition, rheumatism has a long course and many side effects of drugs.
Regular testing of related indicators in the blood of patients is of great significance for judging disease activity and monitoring adverse drug reactions.

The classification of rheumatism is diverse.
The classification of rheumatism includes more than 100 diseases in a broad sense, covering infectious, immune, metabolic, endocrine, hereditary, degenerative, neoplastic, endemic, toxic, etc.
Diseases caused by various reasons.

In a narrow sense, it is limited to dozens of diseases in the fields of internal medicine and immunity.

Specifically divided into: 1.
Mainly arthritis: such as rheumatoid arthritis (RA), Still disease is divided into juvenile and adult, ankylosing spondylitis (AS), psoriatic arthritis; 2.
and Infection-related: such as rheumatic fever, Lyme disease, Wright syndrome, reactive arthritis; 3.
Diffuse connective tissue disease: systemic lupus erythematosus (SLE), primary Sjogren’s syndrome (pSS), systemic Sclerosis (SSc), polymyositis (PM), dermatomyositis (DM), mixed connective tissue disease (MCTD), vasculitis.

Rheumatism check index 1 Anti-streptococcal hemolysin "O" (ASO) A group streptococcus (GAS) infects the human body, B lymphocytes will produce ASO, surrounded by a beta hemolytic ring 2-4 times the diameter of the colony, so GAS Belongs to beta hemolytic streptococcus, also known as ASO.

ASO starts to increase 7-10 days after streptococcal infection, reaches a peak in 2-3 weeks, stabilizes in 3-6 months, and gradually decreases after 6 months.

The World Health Organization (WHO) recommends that infected patients recheck ASO within 10-14 days.
If ASO has a 4-fold increase in titer, it indicates that there is a recent GAS infection.

Clinical Significance of ASO After patients diagnosed with hemolytic streptococcal infection, active rheumatic fever, scarlet fever, and erysipelas, ASO increased.

(1) ASO is commonly known as anti-"O", and its titer can be determined to know whether the patient has had hemolytic streptococcus infection recently or before.

In view of the fact that group A hemolytic streptococcus infection is quite common, normal people can detect low ASO titer, but it is generally below 500U.

(2) Increased ASO is common in upper respiratory tract infections such as acute pharyngitis, and it is more common in children.

In addition, it can also be seen in acute skin and soft tissue infections.

(3) Rheumatic myocarditis, pericarditis, rheumatoid arthritis, and acute glomerulonephritis can increase ASO titer.

The trend of the results of multiple tests will be parallel to the condition, and if it gradually decreases, it indicates that the condition is getting better.

(4) In group A, sepsis and bacteremic endocarditis caused by hemolytic streptococcus can increase ASO.

▎Precautions: (1) ASO positive ≠ group A hemolytic streptococcal infection ≠ rheumatic fever; (2) If the patient is pure ASO positive, has no clinical symptoms, no history of rheumatic fever, or pharyngitis and tonsillitis, this is not required Treatment; (3) If the patient is pharyngitis and tonsillitis, primary prevention is required, but primary prevention does not mean using long-acting penicillin; (4) Patients who have suffered from rheumatic fever need secondary prevention.

2C-reactive protein (CRP) CRP is one of the inflammatory reactive proteins.
CRP increases when the condition of rheumatism is active, which is closely related to the condition.

However, SLE, PM, and SSc can't change CRP significantly, so they can be used to identify rheumatism.

The clinical significance of CRP (1) All kinds of acute purulent inflammation, bacteremia, tissue necrosis (such as myocardial infarction, major surgery, burns, severe trauma, etc.
), malignant tumors, connective tissue diseases and other patients have elevated CRP.CRP is elevated in organic lesions and normal in functional lesions, which is helpful for distinguishing organic or functional diseases.

It is worth noting that when the CRP is greater than 20mg/L, it is the prompt value of the medical decision level, which strongly suggests the existence of the above conditions, and prompt diagnosis and treatment should be taken.

(2) If acute rejection of renal transplantation occurs, serum CRP will increase.

(3) CRP can be significantly increased during the active phase of acute rheumatic fever, even up to 200mg/L.
After treatment improves, CRP can gradually decrease to normal.

This has important reference value for the diagnosis and curative effect observation of rheumatic fever.

(4) CRP does not increase in viral infections, but increases in bacterial infections, so it is of reference value when it is necessary to distinguish whether the pathogen is a bacteria or a virus.

▎Precautions (1) CRP is a non-specific index, and its significance should be considered in conjunction with clinical signs and related laboratory examination items; (2) CRP in pregnant women is easy to increase; (3) CRP can be increased by a factor of 24 within 24 hours of major surgery; (4) ) The younger the child is, the lower the CRP is.
Attention should be paid to the diagnosis.

Rheumatoid factor (RF) RF is an autoantibody with the Fc fragment of denatured IgG as the target antigen, and it is also one of rheumatoid-related autoantibodies.

The clinical significance of RF (1) Although the negative and positive of RF cannot be used to diagnose RA directly, it is also one of the important reference values ​​for the diagnosis of RA.
The negative and positive of RF can increase the accuracy of the diagnosis of RA.

(2) The positive RF can also imply the future development of RA to a certain extent.

RF-positive RA patients have more severe joint disability and disease reactions than RF-negative RA patients.

According to clinical follow-up survey data, the higher the RF value, the more painful and swollen joints in RA cases.
The persistently high-titer RF-positive cases are more likely to have erosive damage to the joint bone, and the greater the possibility of concurrent damage to the external organs.
.

▎Precautions Although RF is an important test index for the diagnosis of RA, a positive RF does not necessarily mean that it is caused by RA, or a negative RF can completely rule out RA.

Therefore, if you want to completely diagnose or rule out RA, you can't just look at RF, but combine RF, erythrocyte sedimentation rate (ESR), anti-CCP antibodies and CRP and other indicators and comprehensive consideration of RA clinical response.

4ESRESR is also called erythrocyte sedimentation rate.
ESR increases when patients with rheumatism are active, but an increase in ESR does not mean that they have rheumatism.

ESR can decrease with the remission of rheumatism, and can be used as one of the indicators of drug efficacy, but it is not a specific indicator of disease activity, and sometimes ESR is not consistent with disease activity.

The clinical significance of ESR (1) Auxiliary examination to diagnose acute or localized infections and chronic active infections; (2) Increased physiological ESR: children under 12 years old or seniors over 60, women menstrual period and three months of pregnancy to one postpartum Month; its increase may be related to physiological anemia or increased fibrinogen content; (3) increased pathological ESR: various inflammatory diseases: such as acute bacterial inflammation, rheumatic fever, tuberculosis and so on.

ESR is most commonly used clinically to observe the activity and dynamic changes of tuberculosis and rheumatic fever.

The ESR increases rapidly during the active period of the disease.
If the disease gradually becomes static, the ESR gradually becomes normal; tissue damage and necrosis: larger tissue damage, surgical trauma, and tissue necrosis after organ infarction can cause ESR to accelerate.

Therefore, the ESR results can be used to distinguish functional and organic diseases.

For example, ESR increases in AMI, and ESR is normal in angina.

Malignant tumors: ESR is usually normal for benign tumors, and when patients with malignant tumors are significantly effective after surgery, chemotherapy or radiotherapy, ESR will gradually become normal, but the cancer can recur or metastasize faster.

Relative or absolute increase in plasma globulin caused by various reasons: such as chronic nephritis, liver cirrhosis, multiple myeloma, macroglobulinemia, lymphoma, SLE, subacute infective endocarditis, kala-azar, etc.

Others: In some patients with anemia, when Hb<90g/L, ESR can increase slightly.

In addition, patients with atherosclerosis, DM, nephrotic syndrome, and mucinedema have high blood cholesterol, and ESR also increases.

(4) ESR slows down: When the clinical significance is small, severe anemia, spherocytosis, and severe lack of fibrin content, ESR can be slowed down.

5 Anti-cyclic citrullinated peptide (CCP) antibody Anti-CCP antibody is a polypeptide fragment of cyclic filaggrin.
It is an IgG-based antibody, which has high sensitivity and specificity to RA, and is positive for anti-CCP antibodies.
Bone destruction in RA patients is more serious than those with negative anti-CCP antibodies.

The clinical significance of anti-CCP antibodies (1) Anti-CCP antibodies can be used as the best indicator for early diagnosis of RA.

Studies have found that about 70% of RA patients can have anti-CCP antibodies in their serum at the early stage of onset, and that patients with positive antibodies are more likely to develop bone and joint damage detected by radioactive methods than those with negative antibodies.

(2) Anti-CCP antibodies are significantly correlated with disease changes, joint destruction, and prognosis of RA patients.

Both joint synovium and peripheral blood lymphocytes of RA patients can secrete anti-CCP antibodies, which is related to the destruction of bones and joints.

Nowadays, domestic and foreign literatures have reported that anti-CCP antibodies are closely related to the severity of the disease, especially the erosive changes in imaging.

Therefore, anti-CCP antibodies can be used for RA disease monitoring and prognosis evaluation.

(3) The combined detection of anti-CCP antibodies and RF can improve the sensitivity and specificity of RA diagnosis, and can be applied to the early diagnosis and prognosis evaluation of RA, which helps to improve the diagnosis of early RA patients.

At present, the combined detection of anti-CCP antibody and RF is widely used in the early diagnosis of RA, especially for early RA patients with atypical clinical symptoms.

Reference materials: [1] Ma Chunli.
The clinical significance of ASO positive in the diagnosis of hemolytic streptococcus infection[J].
The Journal of Practical Clinical Medicine 2015, Volume 19, Issue 17, Pages 188-189, ISTIC CA, 2015, 19(17) ):188-189.
[2]Sun Fei.
The diagnostic value of RF, CRP, and immunoglobulin detection for rheumatism[J].
World Latest Medical Information Abstracts,2019,v.
19(90):179+214.
[ 3] Luo Xiao, Huang Mingzhu, Lu Yue, Li Weizheng, Huang Yunping.
Comparative analysis of uric acid, antistreptolysin O and rheumatoid factor content in patients with different types of arthritis[J].
Chinese Medical Engineering,2020,v.
28( 09):25-27.
[4]Kumar S,Ram R,Sarkar A,et al.
Rapid determination of erythrocyte sedimentation rate(ESR) by an electrically driven blood droplet biosensor[J].
Biomicrofluidics,2020,14(6) .
[5],,.
Clinical application of anti-cyclic citrullinated peptide antibody, rheumatoid factor, C-reactive protein, erythrocyte sedimentation rate in rheumatoid arthritis[J].
Chinese Journal of Health Laboratory Sciences ,2019,v.
29(23):76-78.