Vectra DA

Synonyms: MBDA (multibiomarker disease activity) test CPT Code: 84999, 81479, 83520 Definition: Vectra DA is a multibiomarker based assay designed to correlate with disease activity in rheumatoid arthritis (RA). Description: Vectra DA measures 12 serum inflammatory and disease activity biomarkers and reports a composite score ranging from 0-100.  The choice of its 12 analytes and weighting was based on correlations with validated outcome and activity measures from analyses of RA patients. Read more [...]

Dermatomal Map

Description: The dermatomal map below can be used to a) identify the level of spinal cord/nerve involvement based on patient complaint or b) as an acccompaniment to the sensory nerve exam to determine the distribution of peripheral or spinal nerve comprise. Contralateral comparison is often necessary to determine the abnormality. (Reproduced from Gilroy J, Holliday PL. Basic neurology. New York: Macmillan, 1982, with permission.)  Read more [...]

Diagnosis: A Users Guide

The first section of this textbook is dedicated to the the evaluation and diagnosis of rheumatic complaints. An accurate diagnosis is obtained with the aid of a skillful clinical history and physical examination, with or without the aid of synovial fluid analysis, diagnostic tests or musculoskeletal imaging.  While all topics are alphabetically arranged, the diagnosis section begins with chapters  on the evaluation of musculoskeletal complaints, synovial fluid analysis and arthrocentesis of specific Read more [...]

14-3-3η (eta)

Synonyms:  IdentRA CPT Codes:  86431, 86200, 83520 Description:  14-3-3η (eta) is a new test that may be useful in diagnosing patients with early undifferentiated polyarthritis or may be a marker for those who have a greater risk of developing rheumatoid arthritis (RA) or erosive arthritis.  14-3-3η is one isoform from a family of chaperone proteins involved in intracelluar and extracelluar signaling. 14-3-3η is not known to have a pathogenic role in RA but has been shown to induce Read more [...]

Evaluation of Musculoskeletal Complaints

Over 25% of all adult out-patient primary care evaluations are for musculoskeletal complaints and half of all clinic visits will include arthritis or rheumatic disease as comorbid problem.  A focused rheumatologic evaluation should be considered for those with focal or widespread musculoskeletal complaints, systemic features, physical or functional limitations, or those with abnormal laboratory or imaging results suggesting a rheumatic disorder. Although the goal is an early and accurate diagnosis, Read more [...]

Remitting Seronegative Symmetric Synovitis with Pitting Edema (RS3PE)

Definition: Remitting inflammatory arthritis of hands and feet affecting primarily the elderly. The etiology is unknown. One-half of patients are HLA-B7 positive. Demographics: Older males, >50 years of age, are predominantly affected. Cardinal Findings: Abrupt onset of marked dorsal swelling of the hands (or feet) with pitting edema, wrist synovitis, and flexor finger tendinitis. Most cases remit in a year; fewer cases develop into RA, SpA, or malignancy. Therapy: Good response to low-dose Read more [...]

Rheumatoid Factor

Description: RFs are autoantibodies that react with the Fc portion of IgG. The major immunoglobulin classes are capable of demonstrating RF activity, but the usual routine laboratory assays detect primarily IgM RF. Methods: Classically, IgM RF in serum is detected by agglutination of IgG-coated particles. The source of IgG may be human or rabbit because human IgM RF reacts with IgG molecules from various species. The particles may be latex beads or tanned erythrocytes. Addition of test serum in Read more [...]

Protein: Urine

Description: Quantitative tests for proteinuria are commonly performed. Normal persons may secrete approximately 150 mg of protein into the urine in a 24-hour period. Albumin constitutes only a fraction of this (15–40 mg); the remainder is composed of many different proteins derived predominantly from the renal cells. The most prevalent of these is the Tamm-Horsfall mucoprotein derived from the loop of Henle, which is made in amounts of as much as 50 mg/day. Increased amounts of protein in the Read more [...]

Nailfold Capillaroscopy

Synonym: Wide-field nailfold capillaroscopy. Description: Easily performed, this test examines nailfold capillary architecture by microscopy. Although not truly specific, the test is useful in distinguishing primary and secondary Raynaud's phenomenon. Secondary Raynaud disease refers to Raynaud phenomenon in the setting of another connective tissue disorder (e.g., systemic sclerosis, CREST syndrome, RA, or SLE). Method: A clean nailbed from the third and fourth (preferred) fingers should Read more [...]

Myositis-Specific Autoantibodies

Synonym: Anti-synthetase antibodies Description: Approximately 60% to 80% of patients with inflammatory myopathies have autoantibodies. Some of these, such as ANAs, are seen in other syndromes and are not specifically associated with muscle disorders. However, approximately half of patients with autoantibodies show antibody specificities that are exclusively seen in association with inflammatory muscle disease. Most myositis-specific autoantibodies (MSAs) are directed against intracellular (usually Read more [...]

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