Laboratory Testing for Rheumatoid Arthritis Get it Right the First Time

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Rheumatoid arthritis (RA) is an autoimmune disease that can lead to the destruction of joints and loss of mobility.1,2 The intra-articular bone erosion usually occurs early during disease progression with 30 percent of RA patients having radiographically confirmed erosions at diagnosis and 70 percent three years later.2 The early differential diagnosis of RA from clinically similar diseases (e.g., osteoarthritis) is needed for the initiation of adequate treatment that can slow down the disease progression, prevent bone erosion, and improve the patient’s quality of life.1-3 The median time for a patient to start disease-modifying-antirheumatic drugs (DMARD), from onset of symptoms, is almost 12 months.4 

In combination with other clinical information, serological tests for anti-citrullinated protein antibodies/anti-cyclic citrullinated peptide antibodies (ACPA/anti-CCP) and rheumatoid factor (RF) IgM, which are included in the 2010 ACR/EULAR classification guidelines, as well as RF IgA enable the clinician to come to a well-informed patient diagnosis.1,5,6

  • Anti-CCP and RF IgM can be detected prior to the onset of symptoms and are associated with more severe RA.2,5
  • Double positivity for RF IgM and RF IgA is highly specific of the diagnosis of RA patients.5,6
  • Elevated RF IgA correlates with disease activity and might lead to a poor clinical response to TNF-α inhibitors.5,7


Why choose Thermo Fisher Scientific as your partner in rheumatoid arthritis diagnostics?

  • Best-in-class. The EliA™ CCP test is the most specific, fully automated, anti-CCP test available.8 It comprises the second generation CCP (CCP2), which is considered the “gold standard antigen” for ACPA/anti-CCP tests.9
  • Isotype specific RF testing. In contrast to agglutination based (e.g., nephelometric or turbidimetric) RF assays, EliA™ RF IgM and EliA™ RF IgA tests are RF isotype specific.10
  • High specificity. The addition of positive results to EliA™ RF IgM and EliA™ RF IgA tests, to a positive EliA CCP test, improves the specificity of testing to almost 100 percent.11
  • Unrivaled efficiency. Test for markers of rheumatoid arthritis, connective tissue diseases, autoimmune thyroid diseases, antiphospholipid syndrome, celiac disease, pernicious anemia, autoimmune liver diseases, and ANCA-associated vasculitis all on the same Phadia™ Laboratory Systems, helping you maximize resources.
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  1. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO, 3rd, et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum. 2010;62(9):2569-81.
  2. Littlejohn EA, Monrad SU. Early Diagnosis and Treatment of Rheumatoid Arthritis. Prim Care. 2018;45(2):237-55.
  3. Santos-Moreno P, Villarreal-Peralta L, Gomez-Mora D, Castillo E, Malpica A, Castro C, et al. Osteoarthritis is the Most Frequent Cause of Rheumathoid Arthritis Misdiagnosis in a Rheumatology Center. Osteoarthritis and Cartilage. 2017;25:S219.
  4. Barhamain AS, Magliah RF, Shaheen MH, Munassar SF, Falemban AM, Alshareef MM, et al. The journey of rheumatoid arthritis patients: a review of reported lag times from the onset of symptoms. Open Access Rheumatol. 2017;9:139-50.
  5. de Brito Rocha S, Baldo DC, Andrade LEC. Clinical and pathophysiologic relevance of autoantibodies in rheumatoid arthritis. Adv Rheumatol. 2019;59(1):2.
  6. Jonsson T, Steinsson K, Jonsson H, Geirsson AJ, Thorsteinsson J, Valdimarsson H. Combined elevation of IgM and IgA rheumatoid factor has high diagnostic specificity for rheumatoid arthritis. Rheumatol Int. 1998;18(3):119-22.
  7. Bobbio-Pallavicini F, Caporali R, Alpini C, Avalle S, Epis OM, Klersy C, et al. High IgA rheumatoid factor levels are associated with poor clinical response to tumour necrosis factor alpha inhibitors in rheumatoid arthritis. Ann Rheum Dis. 2007;66(3):302-7.
  8. Mathsson Alm L, Fountain DL, Cadwell KK, Madrigal AM, Gallo G, Poorafshar M. The performance of anti-cyclic citrullinated peptide assays in diagnosing rheumatoid arthritis: a systematic review and meta-analysis. Clin Exp Rheumatol. 2018;36(1):144-52.
  9. van Venrooij WJ, van Beers JJ, Pruijn GJ. Anti-CCP antibodies: the past, the present and the future. Nat Rev Rheumatol. 2011;7(7):391-8.
  10. Bas S, Perneger TV, Kunzle E, Vischer TL. Comparative study of different enzyme immunoassays for measurement of IgM and IgA rheumatoid factors. Ann Rheum Dis. 2002;61(6):505-10.
  11. Mascialino B, Swiniarski S, Gehring I, Poorafshar M. SAT0645 Diagnostic accuracy of serum autoantibodies multi-testing in rheumatoid arthritis and economic consequences across europe. Annals of the Rheumatic Diseases. 2018;77:1173.