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Latex test tubes (technique Singer-Plo tz): agglutination test qualitative or quantitative. Waaler-Rose Test: hemagglut ination test can be qualitative or quantitative can be done in a microplate or s lide. Nephelometry (quantitative). Turbidimetry (quantitative). Radioimmunoassay (RIA): (can detect IgA rheumatoid factor and IgG class). Enzyme immunoassay (EL ISA): (can detect IgA rheumatoid factor and IgG class). Immunosorbent (rheumatoi d factor can detect IgA and IgG class). SAMPLE: • Serum free of hemolysis, and turbid hyperlipemic sera may affect the r esults. STORAGE: • Ambient temperature: 24 hours Refrigerated: 1 week Frozen: 2 weeks. Quantitative nephelometry NORMAL VALUES: • • • No reagent for RA factor: 0 to 39 IU / ml Weakly reactive: 40-79 IU / ml reagent:> 80 IU / ml Latex test: it is considered positive when the dilution is equal to 1 / 64. Late x Test: Sensitivity: 81.6% in bonds 1 / 20 78% in bonds of 1 / 80 In Waaler Rose : positive from 1 / 32. Summary • Rheumatoid factor (RF) is an immune serological test. This test often (70 to 80% ) is positive in people with RA. A result of more than 40 IU could be considered abnormal, the results can reach up to 2000 IU or more, or can be expressed with a smaller number indicating the dilution of the blood which was measured FR (ti tle). 1 http://quimicosclinicosxalapa04.spaces.live.com • • • • Tests may be negative during the first months, making the test less useful for e arly diagnosis. These factors also exist in patients without any disease and pat ients with other diseases, but less frequently than in those with RA. The FR can sometimes indicate the activity of the disease, when the number is high, the di sease is more active and when low, the fact remains, though the FR is not specif ic for rheumatoid arthritis and may rise due to infection, flu , etc. The FR in some cases may be negative even though you have HR, this is called seronegative RA. The AR will never be diagnosed solely on this analysis. Positive results in conjunction with a physical examination (and many other tests as needed), which points to RA can help make the diagnosis. GENERAL Rheumatoid factors (RF) are autoantibodies of the IgG Fc antifragmento l eading to the formation of immune complexes capable of fixing complement and act on cell membranes, the vascular wall and the synovium. Cause changes (increased permeability and inflammatory responses) that ultimately lead to destruction of the synovial membrane, cartilage and bone. They are antibodies against antigens specific organ can be found in serum and synovial fluid. It is postulated that their appearance may be due to genetic factors, persistence of heterologous anti gens and the modification of IgG with specificity to a particular antigen. The u nion with this antigen lead to a conformational change in its structure that mak es it recognized as foreign by the immune system. They have different sizes and
different molecular specificity. The serum rheumatoid factor is the expression of an individual's immune system eacts to the presence of an immunoglobulin that is recognized as "not proper." his immune response "no person" is in the presence of immune complexes. These, n turn, fix complement and may eventually lead to destruction of cartilage and one. It is a polyspecific antibody that activates complement. May react with: • • • r T i b
Different antigenic determinants of the Fc fragment of native human IgG or aggre gated. Neoantigens formed by IgG immune complexes. With nuclear antigens or hapt ens groups, dinitro or trinitroferol. 2 http://quimicosclinicosxalapa04.spaces.live.com CLINICAL UTILITY • • This test is used to diagnose rheumatoid arthritis. Quantif ies rheumatoid factors (antibodies against the Fc fragment of IgG). These are us ually IgM antibodies, but may be IgG or IgA. The blood of many patients with rheumatoid arthritis contain an antibody called rheumatoid factor macroglobulin type, the evidence suggests that rheumatoid fact or antibodies are immunoglobulins gamma, however, until they discover a specific antigen to produce rheumatoid factor, alone and nature can speculate accurate. Knowledge about the role of rheumatoid factor to rheumatoid arthritis are even m ore scarce.Although rheumatoid factor creates or perpetuates destructive change s of rheumatoid arthritis, it is also possible that these changes are accidental or may have a beneficial purpose. Rheumatoid factor is observed in the serum of some patients with other diseases, although both the number and frequency are g reater in cases of rheumatoid arthritis. • • senior titles correlate with the pr esence of rheumatoid nodules, and low complement in synovial fluid. Rheumatoid f actor can be detected in synovial fluid, but in smaller numbers than in serum. C ertain rheumatoid factors can behave as cryoglobulins. Rheumatoid factor product ion may be regulated by anti-idiopathic, Ig.G antibodies directed against specif ic sites on the Fab fragment. It must complete four diagnostic criteria for rheumatoid arthritis: criteria of the American College of Rheumatology FOR THE DIAGNOSIS OF RHEUMATOID ARTHRITIS. • • • • • • • Morning stiffness lasting less than six weeks. Pain with motion or tenderness at least one joint and at least six weeks. Edema at least one joint and at least six weeks. Edema of three joints with less than six weeks. Symmetri c joint swelling, that is, located in the same joint on both sides of the body.) Subcutaneous nodules. Radiographic changes include bone decalcification. 3 http://quimicosclinicosxalapa04.spaces.live.com DIAGNOSTIC When a patient improves with positive results, subsequent results als o remain positive (unless the initial certification is reduced). • A positive te st for rheumatoid factor supports the presumptive diagnosis of early rheumatoid arthritis. Rheumatoid factors occur in conditions such as: • • • • • • • • • • • • • • • • • Sjögren syndrome (75-95%) Scleroderma (20-30%) Dermatomiosistis (510%), Mononucleosis Infectious Hepatitis Viral Sarcoidosis (10%) Waldenström mac roglobulinemia (25%) inflammatory liver disease syphilis (10%) bacterial endocar ditis Systemic Lupus Erythematosus Tuberculosis Infection spread (15-35%) cryogl obulinemia type 2 (40-100%) Polymyositis (20% ) Mixed connective tissue disease (50-60%), subacute bacterial endocarditis (40%), interstitial pulmonary fibrosis (30-60%), liver cirrhosis (25%), leprosy (25%), tuberculosis (15%) . They occur in 10-20% of patients with rheumatoid arthritis (RA) in children. Patients with
skin and renal allografts The absence of rheumatoid factor does not exclude the diagnosis of rheumatoid ar thritis. Preanalytical variables: Increase: • The incidence of positive rheumatoid factor increases with age older than 70 years between 1025% for both in patients with suspected rheumatic disease in this group treasury a positive result should be i nterpreted taking into account the low specificity test. 4 http://quimicosclinicosxalapa04.spaces.live.com • Exposure to mercury, race, silicone implants, smoking and a low percentage of healthy people in normal population. REFERENCES: Fisbach, Talasaka, Frances, Manual of diagnostic tests, 5th Edition, 1997, Editorial McGrawHill, Mexico, website: http http://www.arthritis.org/espa nol/tengo-artritis-pruebas-analisis-sangre.php 613.614 : / / www.lablasamericas. com.co/newDB/examenes.php?codigo_examen=F076 http://www.tuotromedico.com http:// www.farestaie.com.ar 5