The clinical significance of the four rheumatism items

Rheumatism is a common autoimmune disease and many people suffer from it. When patients go to the hospital for examination, they will be tested for four rheumatism items. In order to get a better cure, patients need to cooperate with the doctor's examination and follow the doctor's instructions. The four rheumatism items are an important indicator for examining rheumatism. What practical help can be provided to rheumatic patients? What is the clinical significance of the four rheumatism tests?

Clinical significance

● CRP, as an acute phase protein, increases rapidly within a few hours after the onset of various acute inflammations, tissue damage, myocardial infarction, surgical trauma, radiation damage and other diseases, and has a tendency to increase exponentially. The increase is positively correlated with the degree of infection.

● CRP is closely correlated with other inflammatory factors such as total white blood cell count, erythrocyte sedimentation rate, and polymorphonuclear leukocytes;

● CRP can be used to differentiate between bacterial and viral infections. CRP is usually normal in viral infections.

● CRP is usually elevated in patients with malignant tumors. CRP determination has positive significance in the treatment and prognosis of tumors. CRP increases before surgery and decreases after surgery, and its response is not affected by radiotherapy, chemotherapy, and corticosteroid treatment, which helps clinically evaluate the progression of tumors.

● CRP is used to assess the severity of acute pancreatitis. When CRP is higher than 250 mg/L, it may indicate extensive necrotizing pancreatitis.

Erythrocyte sedimentation rate (ESR)

● ESR is the rate at which red blood cells settle under certain conditions. Its mechanism has not yet been elucidated, but ESR is the result of the interaction of multiple factors. These factors include:

● Plasma factors (e.g. increased fibrinogen or globulin in plasma can increase the erythrocyte sedimentation rate);

● Red blood cell factors (such as a decrease in the total area of ​​red blood cells or an increase in the diameter and thickness of red blood cells, and an increase in the erythrocyte sedimentation rate);

● The position of the ESR tube (if the tube is tilted, the ESR rate will increase)

● Temperature (the room temperature should be between 18-25°C, as higher temperature will increase the ESR rate)

● The ratio of anticoagulant to blood (blood should be collected to the 2ml mark as required. More anticoagulant will slow down the erythrocyte sedimentation rate, and vice versa)

Normal reference value: Male: 0-15 mm/h Female: 0-20 mm/h

Clinical significance: Accelerated erythrocyte sedimentation rate often indicates inflammatory response in joints and adjacent tissues and the occurrence of hyperglobulinemia, and thus reflects the severity and activity of the disease to a certain extent. In addition, regular checks of the ESR can be used to observe the effectiveness of treatment. If the ESR gradually slows down, it means that the treatment is effective. On the contrary, if the ESR does not decrease significantly or continues to increase, it means that the treatment is ineffective.

Rheumatic diseases are numerous and complex. Various laboratory tests are essential in the diagnosis and treatment of patients. The test results are also a very complex issue, and often require doctors to conduct a comprehensive analysis and judgment based on the patient's condition in order to make a more objective and correct diagnosis. The following introduces common rheumatic disease test indicators - the four rheumatic items (anti-o, rheumatoid factor, C-reactive protein, and erythrocyte sedimentation rate).

Antistreptolysin "O" (ASO)

Normal reference value: 0～200U/L by immunoturbidimetry

Clinical significance

● Increased: rheumatic fever, hemolytic streptococcal infection, acute glomerulonephritis, subacute endocarditis and other diseases. A test used to detect whether rheumatic disease is in the active stage, during which 60-80% can increase;

● An increase in anti-"O" can only mean that the patient has recently been infected with hemolytic streptococci, but it does not necessarily mean that the patient will suffer from rheumatic fever, rheumatoid arthritis and rheumatic heart disease. It is necessary to test the anti-streptococcal bacterial antigen at the same time and combine it with clinical manifestations;

● Since people often come into contact with Group A Streptococcus, normal people also have low-titer antibodies, usually <133IU/ml. When the titer is >200IU/ml, it is considered to have diagnostic value. 15-20% of healthy people have serum ASO levels higher than 200 IU/ml.

Rheumatoid factor (RF)

Normal reference value: turbidimetry 0～20U/L

Clinical significance

● It has certain clinical significance for the diagnosis and prognosis of patients with rheumatoid arthritis (RA). The RF positivity rate of RA patients is 52% to 92%. Generally, RF-positive patients have poor therapeutic effects and are accompanied by other complications, such as peripheral neuritis and arteritis; RF-negative patients have milder conditions, fewer complications, and better therapeutic effects. Negative conversion of RF or decrease in content can be used as an indicator to evaluate drug efficacy and disease remission;

● RF can be used for auxiliary diagnosis of autoimmune diseases: the RF positivity rate of SLE is 53%, dermatomyositis, scleroderma and pernicious anemia are all 80%, autoimmune hemolytic anemia is 75%, chronic active liver disease is 60%, and Sjögren's syndrome can reach 90% to 100%. RF may also be positive in chronic infectious diseases such as subacute bacterial endocarditis, tuberculosis, syphilis, kala-azar, sarcoidosis, and certain hyperglobulinemias;

● Clinical significance of various types of RF: IgG RF is closely related to synovitis, vasculitis and extra-articular symptoms in RA patients; IgA RF is seen in RA, scleroderma, Felty's syndrome and SLE, and is a sign of clinical activity; the content of IgM RF is not closely related to the activity of RA; the clinical significance of IgD RF is currently unclear; IgE RF is seen in RA, Felty's syndrome and juvenile RA, and the IgE RF in joint fluid and pleural effusion is higher than the serum level of the same patient.

C-Reactive Protein (CRP)

Normal reference value: immune scattering turbidimetry 0～8mg/l