自身免疫血清学检测结果对类风湿关节炎分类和诊断的影响

IF 4.7 Q2 IMMUNOLOGY
Lieve Van Hoovels , Paul Studenic , Daniela Sieghart , Günter Steiner , Xavier Bossuyt , Johan Rönnelid
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引用次数: 13

摘要

类风湿性关节炎(RA)是最常见的系统性自身免疫性疾病,也是最严重的关节炎疾病。血清中类风湿因子(RF)和抗瓜氨酸化蛋白抗体(ACPA)的测定支持RA的诊断,这在过去65年中越来越重要。然而,RF和ACPA方法之间的高度可变性已经被描述,影响了当前ACR/EULAR RA分类标准的诊断性能。大量的市售检测,往往缺乏对国际标准的可追溯性,是导致这种中间检测可变性的主要因素。因此,采用ACPA的国际标准是非常可取的,因为长期以来可用于类风湿因子。基于疾病控制中预定义的特异性,通过协调低抗体水平和高抗体水平的截止值,可以进一步协调RF/ACPA检测的临床解释。报告测试结果特异性似然比(LR)增加了自身抗体测试解释的价值。然而,很好地了解用于定义抗体检测结果间隔相关LRs的对照人群对于定义抗体血清学的诊断性能特征至关重要。最后,考虑到抗体的性质、抗体水平和RF + ACPA双阳性,可以通过改进血清学权重评分来提高RA分类的特异性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Impact of autoimmune serology test results on RA classification and diagnosis

Impact of autoimmune serology test results on RA classification and diagnosis

Impact of autoimmune serology test results on RA classification and diagnosis

Impact of autoimmune serology test results on RA classification and diagnosis

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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来源期刊
Journal of Translational Autoimmunity
Journal of Translational Autoimmunity Medicine-Immunology and Allergy
CiteScore
7.80
自引率
2.60%
发文量
33
审稿时长
55 days
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