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Impact of autoimmune serology test results on RA classification and diagnosis. | LitMetric

AI Article Synopsis

  • Rheumatoid arthritis (RA) is the most common and severe autoimmune disease, with RF and ACPA tests being crucial for its diagnosis.
  • Variability between different RF and ACPA testing methods affects the effectiveness of RA classification criteria, partly due to a lack of international assay standards.
  • To enhance diagnostic accuracy, it is important to establish standard test cut-offs, use specific likelihood ratios for interpreting results, and refine scoring systems that consider various factors, including antibody levels and dual positivity.

Article Abstract

Rheumatoid arthritis (RA) is the most common systemic autoimmune disease and also the most severe arthritic disorder. The measurement of rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA) in serum supports the diagnosis of RA, which gained increasing significance over the last 65 years. However, a high variability between RF and ACPA methods has been described, impacting the diagnostic performance of the current ACR/EULAR RA classification criteria. The great number of commercially available assays, often lacking traceability to an international standard, is a major factor attributing to this in-between assay variability. The adoption of an international standard for ACPA, as is since long available for rheumatoid factor, is therefore highly desirable. Further harmonization in clinical interpretation of RF/ACPA assays could be obtained by harmonization of the cut-offs, for both the low and high antibody levels, based on predefined specificity in disease controls. Reporting test result specific likelihood ratios (LR) adds value in the interpretation of autoantibody tests. However, a good understanding of the control population used to define antibody test result interval-associated LRs is crucial in defining the diagnostic performance characteristics of antibody serology. Finally, specificity in RA classification can be improved by refining serological weight scoring taking into account the nature of the antibody, the antibody level and double RF + ACPA positivity.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8749172PMC
http://dx.doi.org/10.1016/j.jtauto.2022.100142DOI Listing

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