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Rheumatology for GP Trainees: Autoantibody testing 2013

Rheumatology for GP Trainees: Autoantibody testing 2013. Dr Martin Lee MRCP(Rheum) Rheumatology Consultant, Honorary Senior Clinical Lecturer & Associate Clinical Sub Dean Freeman Hospital, Newcastle. Autoantibodies: Introduction. RF and Anti-CCP (Early Diagnosis) ANA ANCA.

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Rheumatology for GP Trainees: Autoantibody testing 2013

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  1. Rheumatology for GP Trainees:Autoantibody testing 2013 Dr Martin Lee MRCP(Rheum) Rheumatology Consultant, Honorary Senior Clinical Lecturer & Associate Clinical Sub Dean Freeman Hospital, Newcastle

  2. Autoantibodies: Introduction • RF and Anti-CCP (Early Diagnosis) • ANA • ANCA

  3. Rheumatoid Factor • Autoantibody to Fc portion of IgG • Present in 10-15% elderly & unwell • 70% Rheumatoid “seropositive” • Important prognosis, NOT diagnosis • No need for serial measurements!

  4. Rheumatoid Arthritis • Aim to identify those subjects with Early IA at risk of chronicity or joint damage RA vs non-RA OR Requiring DMARD vs Not requiring DMARD • Aim is to identify those subjects with Early IA we should be treating with DMARDs to prevent chronicity or damage

  5. Rheumatoid Arthritis • ACR/EULAR 2010 Classification Criteria: • Joint count (small, large, polyarticular, oligoarticular) • RF, Anti-CCP (titre) • Duration of symptoms (<6/52, >6/52) • CRP / ESR

  6. RF testing in Primary Care? • YES if you think synovitis • Needs referral to rheumatology • Provides information for clinic appointment • NO if unsure of diagnosis • Not diagnostic test • GP initiative more useful • 3 or more swollen joints • MCPJ squeeze positive

  7. Anti–CCP antibody • As sensitive & more specific RA • >95% specific • Asymptomatic Anti-CCP positive patients? • Strong correlation with erosive disease • Cost • Suggest it should be a secondary care test

  8. ANA in Primary Care • Immunofluorescence test • Anti-centromere, speckled etc. • Positive 5% normal population • Higher in “unwell” population • Dilution 1:160 ‘significant’ cut-off

  9. ANA in Primary Care • SLE - > 99% +ve • Scleroderma – 60% • Myositis – 30-40% • Subtypes – ENA • More disease specific • dsDNA • e.g. Anti Ro/La Ab in Sjogren’s

  10. ANA testing in Primary Care? • Difficult! • What question are you asking? • Likely CTD & going to refer – YES • Diagnosis uncertain & screening - NO

  11. ANCA • Two subtypes: • c-ANCA (Wegener’s) • PR3 specific • Monitor disease activity • p-ANCA (non-specific) • Microscopic polyangitis • Churg-Strauss

  12. ANCA in Primary Care? • ? Vasculitis • Unwell • Skin rash • Hypertension • Proteinuria • Needs urgent rheum opinion – not ANCA

  13. Summary • Rheum Factor – Yes if synovitis • Please refer early • ?Early synovitis clinic/CCP may be coming • ANA – only if significant suspicion CTD • ANCA – not in primary care

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