Three minutes to teach you to "understand the three items of rheumatism" test sheet

*It is only for medical professionals to read and reference.
It is actually very simple~ 1.
What are included in the "three items of rheumatism"? There are many manifestations of rheumatology diseases, and the condition is more complicated.
When going to the hospital for examination, various items are dazzling
.

The test results were also confusing
.

But for rheumatoid arthritis (RA), there are three examinations that many hospitals are doing, commonly known as "three rheumatoid items"
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What are the "three items of rheumatism"? Among the many data on the report, which one is the most important? Follow me, let's learn together
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▎C-reactive protein (CRP) When inflammation or tissue necrosis occurs, the serum CRP concentration rises rapidly
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In the active phase of RA, serum CRP increases significantly, which is one of the indicators to observe the disease activity
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But CRP negative, can not rule out RA
.

▎ Rheumatoid factor (RF) RF is a specific antibody against antigenic determinants on human or animal IgGFc fragments, mainly synthesized by plasma cells of synovium and secreted into synovial fluid and blood, spleen, lymph nodes and rheumatoid subcutaneous nodules.
Nodal plasma cells can also be produced
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▎Anti-Streptolysin O (ASO) Streptococcus is an exotoxin produced by Group A Streptococcus.
After the human body is infected with hemolytic Streptococcus, a large amount of ASO (anti-"O") antibodies can appear in the serum
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Therefore, a positive anti-chain "O" can only indicate that there has been a streptococcal infection, and there is no clear relationship with RA
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Therefore, routine diagnostic screening for RA is not appropriate
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2.
How to read the "Three Items of Rheumatism" report? CRP is an infection marker that appears and continues to rise within hours when there is acute inflammation in the body, a more severe bacterial infection, or tissue damage
.

Clinical significance ● CRP, like ESR, is the most effective laboratory index for evaluating the activity of RA; ● CRP, as an acute phase protein, is used in various acute inflammation, tissue damage, myocardial infarction, surgical trauma, radiation injury and other diseases after the onset.
Hourly increased rapidly and had a tendency to increase exponentially, and its increase was positively correlated with the degree of infection; ● CRP was closely related to other inflammatory factors such as the total number of leukocytes, erythrocyte sedimentation rate, and polymorphonuclear leukocytes; ● CRP It can be used for the differential diagnosis of bacterial and viral infections.
Viral infection CRP is usually not elevated or only slightly elevated; normal reference value: immunoturbidimetric RFRF mainly exists in the serum and synovial fluid of RA patients, and is a self- antibody
.

Although RF is named after RA, it can appear in many other diseases, such as Sjögren's syndrome, systemic lupus erythematosus, chronic hepatitis B infection, and malignant tumors
.

In addition, RF can also be detected in 5% of the healthy population
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Although RF is positive, it is not necessarily RA
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However, for high titers of RF (≥3 times the upper limit of normal), the possibility of rheumatic diseases should be carefully investigated in combination with the patient's medical history and physical examination
.

Clinical significance ● Diagnostic significance of RA: The positive rate of RF in RA patients is 52% to 92%.
Whether it is the RA classification standard of ACR in 1987 or the classification standard of RA in ACR/EULAR 2009, RF is used as one of the diagnostic criteria.
Therefore, RF plays a pivotal role in the diagnosis of RA; ● Significance for disease evaluation and prognosis of RA patients: Usually, the higher the RF titer, the more extra-articular lesions (such as rheumatoid nodules, pulmonary lesions, ophthalmia, etc.
) more likely
.

However, the relationship between RF titer and disease activity is not clear, and more depends on changes in clinical and inflammatory indicators; RF can be used for auxiliary diagnosis of autoimmune diseases: RF positive is also seen in other autoimmune diseases, Such as systemic lupus erythematosus, Sjögren's syndrome, dermatomyositis, scleroderma, vasculitis,
etc.

Normal reference value: immune turbidimetric ASOASO is that after the human body is infected with group A hemolytic streptococcus, the human body appears corresponding antibodies to correspond to the hemolysin O produced by it, that is, anti-"O"
.

Clinical significance: ● Increased ASO: seen in rheumatic fever, hemolytic streptococcus infection, acute glomerulonephritis, subacute endocarditis and other diseases; ● increased anti-"O" can only mean that the patient has recently been infected with hemolytic streptococcus, However, rheumatic fever, rheumatoid arthritis and rheumatic heart disease may not necessarily occur.
It is necessary to detect anti-streptococcus bacterial antigens at the same time and make a diagnosis based on clinical manifestations; ● Because people often come into contact with group A streptococcus, normal people also have low levels of The titer of antibodies, usually <133IU/ml, is considered diagnostic value when the titer is >200IU/ml
.

However, 15% to 20% of healthy people have serum ASO levels higher than 200IU/ml
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Normal reference value: immunoturbidimetric method In short, the above indicators are positive, which can be seen in many situations, and clinicians will comprehensively interpret them in combination with clinical symptoms
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Therefore, if the above indicators are positive, do not panic, and go to the rheumatology and immunization department for treatment in time
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Source of this article: Friendship Rheumatism Information Editor in charge of this article: Orange Copyright Statement This article is reprinted, welcome to forward it in the circle of friends~- End -Call for manuscripts "Rheumatology Immunity Channel in the Medical Community" long-term recruitment of online authors, 1.
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