Juvenile Rheumatoid Arthritis

Testing for Juvenile Rheumatoid Arthritis and health information

Learn about juvenile rheumatoid arthritis tests used to screen, diagnose and monitor the conditions and their benefits and effectiveness.

Order your juvenile rheumatoid arthritis test to evaluate and measure blood levels of Rheumatoid factor and antinuclear antibodies, often present in somebody with rheumatic disease.  Learn about your health today with Ulta Lab Tests.

In the guide below the list of tests, we explain and answer your questions on Juvenile Rheumatoid Arthritis tests.


Name Matches

Rheumatoid Factor (IgA, IgG, IgM) 

Reference Range(s)

  • Rhematoid Factor (IgA)
    • ≤6 Negative
    • >6 Positive
  • Rhematoid Factor (IgG)
    • ≤6 Negative
    • >6 Positive
  • Rhematoid Factor (IgM)
    • ≤6 Negative
    • >6 Positive

Rheumatoid factor is commonly used as a blood test for the diagnosis of rheumatoid arthritis. However, rheumatoid factor can also be present in individuals with other conditions such as lupus, infectious hepatitis, syphilis, mononucleosis, tuberculosis, liver disease, and sarcoidosis. Rheumatoid factor is an antibody that is detectable in the blood of 80% of adults with rheumatoid arthritis. Rheumatoid can be detected in the blood of normal individuals and of those with other autoimmune diseases that are not rheumatoid arthritis. In people with rheumatoid arthritis, high levels of rheumatoid factor can indicate a tendency toward more aggressive disease and/or a tendency to develop rheumatoid nodules and rheumatoid lung disease. Rheumatoid factor is actually an antibody that can bind to other antibodies. Antibodies are normal proteins in our blood that are important parts of our immune system. Rheumatoid factor is an antibody that is not usually present in the normal individual. Rheumatoid factor is commonly used as a blood test for the diagnosis of rheumatoid arthritis. Rheumatoid factor is present in about 80% of adults (but a much lower proportion of children) with rheumatoid arthritis.

Description: Rheumatoid Factor IgG is a blood test that measures the amount of rheumatoid factor IgG antibodies that are present in the blood’s serum.

Also Known As: RF Antibody Test, Rheumatoid Arthritis Factor Antibody Test, RF IgG Test, RF IgG Antibody Test, Rheumatoid Factor IgG Antibody Test

Collection Method: Blood Draws

Specimen Type: Serum

Test Preparation: No preparation required

When is a Rheumatoid Factor IgG test ordered?

When a person has RA signs and symptoms, an RF test may be ordered. Pain, warmth, swelling, and morning stiffness in the joints are common symptoms, as are nodules under the skin and, if the disease has progressed, signs of enlarged joint capsules and cartilage and bone loss on X-rays. When the first RF test is negative but the symptoms persist, the RF test may be repeated.

A cyclic citrullinated peptide antibody test may be ordered along with RF or if the RF result is negative to help diagnose RA in someone who has joint inflammation but does not yet fit the criteria for RA.

Additional autoimmune-related tests, such as an ANA, as well as other markers of inflammation, such as a CRP and Sed Rate, as well as a CBC to examine blood cells, may be ordered in addition to the RF test.

What does a Rheumatoid Factor IgG blood test check for?

The autoantibody rheumatoid factor is an immunoglobulin M protein produced by the body's immune system. Autoantibodies attack a person's own tissues, mistaking them for "foreign" tissue. While the biological role of RF is unknown, its presence can be used to detect inflammatory and autoimmune activities. This test identifies and quantifies radiofrequency in the bloodstream.

The RF test is an important tool in the diagnosis of rheumatoid arthritis. A RF test will be positive in about 80% of people with RA. RF, on the other hand, can be found in persons with a range of different illnesses, including as Sjögren syndrome, as well as persistent bacterial, viral, and parasite infections, and some malignancies. It can be noticed in patients who have lung, liver, or kidney disease, and it can also be detected in a tiny percentage of healthy persons.

Lab tests often ordered with a Rheumatoid Factor IgG test:

  • Rheumatoid Factor IgM
  • Cyclic Citrullinated Peptide Antibody
  • ANA
  • Sed Rate
  • C-Reactive Protein
  • Immunoglobulins

Conditions where a Rheumatoid Factor IgG test is recommended:

  • Rheumatoid Arthritis
  • Autoimmune Disorders

How does my health care provider use a Rheumatoid Factor IgG test?

The rheumatoid factor test is used to diagnose rheumatoid arthritis and to distinguish it from other types of arthritis or diseases that generate similar symptoms.

While the clinical picture is critical in the diagnosis of RA, some signs and symptoms, particularly in the early stages of the disease, may not be present or follow a predictable pattern. Additionally, the signs and symptoms may not always be easy to distinguish because people with RA may also have other connective tissue disorders such Raynaud phenomenon, scleroderma, autoimmune thyroid problems, and systemic lupus erythematosus and present symptoms of these disorders. When RA is suspected, the RF test is one of several tools that can be used to aid determine a diagnosis.

What do my Rheumatoid Factor test results mean?

The results of the RF test must be interpreted in the context of a person's symptoms and medical history.

The presence of large amounts of RF in persons with symptoms and clinical indications of rheumatoid arthritis indicates that they are likely to develop RA. Higher RF levels are associated with a worse prognosis and more severe illness.

A negative RF test does not rule out the possibility of RA. Around 20% of persons with RA will have very low levels of RF or none at all. In these circumstances, a positive CCP antibody test can be utilized to confirm RA.

Sjögren syndrome, systemic lupus erythematosus, sarcoidosis tuberculosis, syphilis, HIV/AIDS, hepatitis, scleroderma, infectious mononucleosis, cancers such as leukemia and multiple myeloma, or disease of the liver, lung, or kidney may all produce positive RF test These other disorders are neither diagnosed or monitored with the RF test.

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.


Most Popular

Description: RF is a blood test that is measures the amount of rheumatoid factor that is present in the blood’s serum. It is used along with other tests to diagnose rheumatoid arthritis.

Also Known As: RF Test, Rheumatoid Arthritis Factor Test

Collection Method: Blood Draws

Specimen Type: Serum

Test Preparation: No preparation required

When is a Rheumatoid Factor test ordered?

When a person has RA signs and symptoms, an RF test may be ordered. Pain, warmth, swelling, and morning stiffness in the joints are common symptoms, as are nodules under the skin and, if the disease has progressed, signs of enlarged joint capsules and cartilage and bone loss on X-rays. When the first RF test is negative but the symptoms persist, the RF test may be repeated.

A cyclic citrullinated peptide antibody test may be ordered along with RF or if the RF result is negative to help diagnose RA in someone who has joint inflammation but does not yet fit the criteria for RA.

Additional autoimmune-related tests, such as an ANA, as well as other markers of inflammation, such as a CRP and Sed Rate, as well as a CBC to examine blood cells, may be ordered in addition to the RF test.

What does a Rheumatoid Factor blood test check for?

The autoantibody rheumatoid factor is an immunoglobulin M protein produced by the body's immune system. Autoantibodies attack a person's own tissues, mistaking them for "foreign" tissue. While the biological role of RF is unknown, its presence can be used to detect inflammatory and autoimmune activities. This test identifies and quantifies radiofrequency in the bloodstream.

The RF test is an important tool in the diagnosis of rheumatoid arthritis. A RF test will be positive in about 80% of people with RA. RF, on the other hand, can be found in persons with a range of different illnesses, including as Sjögren syndrome, as well as persistent bacterial, viral, and parasite infections, and some malignancies. It can be noticed in patients who have lung, liver, or kidney disease, and it can also be detected in a tiny percentage of healthy persons.

Lab tests often ordered with a Rheumatoid Factor test:

  • Cyclic Citrullinated Peptide Antibody
  • ANA
  • Sed Rate
  • C-Reactive Protein
  • Immunoglobulins

Conditions where a Rheumatoid Factor test is recommended:

  • Rheumatoid Arthritis
  • Autoimmune Disorders

How does my health care provider use a Rheumatoid Factor test?

The rheumatoid factor test is used to diagnose rheumatoid arthritis and to distinguish it from other types of arthritis or diseases that generate similar symptoms.

While the clinical picture is critical in the diagnosis of RA, some signs and symptoms, particularly in the early stages of the disease, may not be present or follow a predictable pattern. Additionally, the signs and symptoms may not always be easy to distinguish because people with RA may also have other connective tissue disorders such Raynaud phenomenon, scleroderma, autoimmune thyroid problems, and systemic lupus erythematosus and present symptoms of these disorders. When RA is suspected, the RF test is one of several tools that can be used to aid determine a diagnosis.

What do my Rheumatoid Factor test results mean?

The results of the RF test must be interpreted in the context of a person's symptoms and medical history.

The presence of large amounts of RF in persons with symptoms and clinical indications of rheumatoid arthritis indicates that they are likely to develop RA. Higher RF levels are associated with a worse prognosis and more severe illness.

A negative RF test does not rule out the possibility of RA. Around 20% of persons with RA will have very low levels of RF or none at all. In these circumstances, a positive CCP antibody test can be utilized to confirm RA.

Sjögren syndrome, systemic lupus erythematosus, sarcoidosis tuberculosis, syphilis, HIV/AIDS, hepatitis, scleroderma, infectious mononucleosis, cancers such as leukemia and multiple myeloma, or disease of the liver, lung, or kidney may all produce positive RF test These other disorders are neither diagnosed or monitored with the RF test.

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.


Clinical Significance

Rheumatoid Arthritis Diagnostic IdentRA® Panel 2 - Early diagnosis of rheumatoid arthritis (RA), ie, diagnosis before significant joint erosion occurs, is difficult. Psoriatic arthritis can also be difficult to diagnose clinically early in the disease process, and there are no specific biomarkers. The 14-3-3η (eta) protein is an emerging biomarker for RA and erosive psoriatic arthritis diagnosis. It may play a biologic role in the joint erosive process. Blood levels appear to be elevated in patients with RA, but not in other diseases including psoriasis, osteoporosis, gout, ulcerative colitis, type 1 diabetes, systemic lupus erythematosus, Crohn disease, primary Sjögren syndrome, scleroderma, and multiple sclerosis. The 14-3-3η protein, used in conjunction with rheumatoid factor (RF) and cyclic citrullinated peptide (CCP) antibody, may improve diagnostic sensitivity in the early diagnosis of RA. It may also help differentiate those with psoriatic arthritis joint damage from those without joint damage.


Description: An antinuclear antibody screening is a blood test that is going to look for a positive or negative result. If the result comes back as positive further test will be done to look for ANA Titer and Pattern. Antinuclear antibodies are associated with Lupus.

Also Known As: ANA Test, ANA Screen IFA with Reflex to Titer and pattern IFA Test, ANA with Reflex Test, Antinuclear Antibody Screen Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

IMPORTANT Reflex Information: If ANA Screen, IFA is positive, then ANA Titer and Pattern will be performed at an additional charge of $13.00

When is an ANA Screen test ordered?

When someone exhibits signs and symptoms of a systemic autoimmune illness, the ANA test is requested. Symptoms of autoimmune illnesses can be vague and non-specific, and they can fluctuate over time, steadily deteriorate, or oscillate between periods of flare-ups and remissions.

What does an ANA Screen blood test check for?

Antinuclear antibodies are a type of antibody produced by the immune system when it is unable to differentiate between its own cells and foreign cells. Autoantibodies are antibodies that attack the body's own healthy cells, causing symptoms like tissue and organ inflammation, joint and muscle discomfort, and weariness. The moniker "antinuclear" comes from the fact that ANA specifically targets chemicals located in a cell's nucleus. The presence of these autoantibodies in the blood is detected by the ANA test.

The presence of ANA may be a sign of an autoimmune process, and it has been linked to a variety of autoimmune illnesses, the most common of which being systemic lupus erythematosus.

One of the most common tests used to detect an autoimmune disorder or rule out other conditions with comparable signs and symptoms is the ANA test. As a result, it's frequently followed by other autoantibody tests that can help establish a diagnosis. An ENA panel, anti-dsDNA, anti-centromere, and/or anti-histone test are examples of these.

Lab tests often ordered with an ANA Screen test:

  • ENA Panel
  • Sed Rate (ESR)
  • C-Reactive Protein
  • Complement
  • AMA
  • Centromere antibody
  • Histone Antibody

Conditions where an ANA Screen test is recommended:

  • Autoimmune Disorders
  • Lupus
  • Rheumatoid Arthritis
  • Sjogren Syndrome
  • Scleroderma

How does my health care provider use an ANA Screen test?

One of the most often performed tests to diagnose systemic lupus erythematosus is the antinuclear antibody test. It serves as the first step in the evaluation process for autoimmune diseases that might impact various body tissues and organs.

When a person's immune system fails to discriminate between their own cells and foreign cells, autoantibodies called ANA are created. They attack chemicals found in a cell's nucleus, causing organ and tissue damage.

ANA testing may be utilized in conjunction with or after other autoantibody tests, depending on a person's indications and symptoms and the suspected condition. Antibodies that target specific compounds within cell nuclei, such as anti-dsDNA, anti-centromere, anti-nucleolar, anti-histone, and anti-RNA antibodies, are detected by some of these tests, which are considered subsets of the general ANA test. In addition, an ENA panel can be utilized as a follow-up to an ANA.

These further tests are performed in addition to a person's clinical history to assist diagnose or rule out other autoimmune conditions such Sjögren syndrome, polymyositis, and scleroderma.

To detect ANA, various laboratories may employ different test procedures. Immunoassay and indirect fluorescent antibody are two typical approaches. The IFA is regarded as the gold standard. Some labs will test for ANA using immunoassay and then employ IFA to confirm positive or equivocal results.

An indirect fluorescent antibody is created by mixing a person's blood sample with cells attached to a slide. Autoantibodies in the blood bind to the cells and cause them to react. A fluorescent antibody reagent is used to treat the slide, which is then inspected under a microscope. The existence of fluorescence is observed, as well as the pattern of fluorescence.

Immunoassays—these procedures are frequently carried out using automated equipment, however they are less sensitive than IFA in identifying ANA.

Other laboratory tests linked to inflammation, such as the erythrocyte sedimentation rate and/or C-reactive protein, can be used to assess a person's risk of SLE or another autoimmune disease.

What do my ANA test results mean?

A positive ANA test indicates the presence of autoantibodies. This shows the presence of an autoimmune disease in someone who has signs and symptoms, but more testing is needed to make a definitive diagnosis.

Because ANA test results can be positive in persons who have no known autoimmune disease, they must be carefully assessed in conjunction with a person's indications and symptoms.

Because an ANA test can become positive before signs and symptoms of an autoimmune disease appear, determining the meaning of a positive ANA in a person who has no symptoms can take some time.

SLE is unlikely to be diagnosed with a negative ANA result. It is normally not required to repeat a negative ANA test right away; however, because autoimmune illnesses are episodic, it may be desirable to repeat the ANA test at a later date if symptoms persist.

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.


ANAlyzeR™ ANA, IFA with Reflex Titer/Pattern, Systemic Autoimmune Panel 1

Includes

  • ANA Screen,IFA, with Reflex to Titer and Pattern
  • DNA (ds) Antibody, Crithidia IFA with Reflex to Titer
  • Chromatin (Nucleosomal) Antibody
  • Sm Antibody
  • Sm/RNP Antibody
  • RNP Antibody
  • Sjogren's Antibodies (SS-A, SS-B)
  • Scleroderma Antibody (Scl-70)
  • Jo-1 Antibody
  • Centromere B Antibody
  • Complement Component C3c and C4c
  • Cardiolipin Antibodies (IgA, IgG, IgM)
  • Beta-2-Glycoprotein I Antibodies (IgG, IgA, IgM)
  • Rheumatoid Factor (IgA, IgG, IgM)
  • Cyclic Citrullinated Peptide (CCP) Antibody (IgG)
  • 14.3.3 eta Protein
  • Thyroid Peroxidase Antibodies (TPO)

 

  • If ANA Screen, IFA is positive, then ANA Titer and Pattern will be performed at an additional charge (CPT code(s): 86039).
  • If the DNA (ds) Antibody Screen is positive, then DNA (ds) Antibody Titer will be performed at an additional charge (CPT code(s): 86256).

 

Alternative Name(s)

Expanded ANA Antibodies,Systemic Autoimmune Disorder,ANA and Expanded AI Testing,ANA and Systemic Autoimmunity,Comprehensive AI Testing,Early Systemic Autoimmune Disease,Autoimmune Disorders


Description: Anti-CCP is a test that measure the amount of cyclic citrullinated peptide in the blood. Anti-CCP is an autobody and it can be used to determine the if a person has Rheumatoid Arthritis.

Also Known As: ACPA, Anti-CCP, Anti-citrulline Antibody, Anti-cyclic Citrullinated Peptide, Anti-Cyclic Citrullinated Peptide (CCP) Antibody IgG, CCP, CCP Antibody, Citrullinated Peptide (CCP) IgG, Cyclic Citrullinated Peptide Antibody, Cyclic Citrullinated Peptide CCP Antibody IgG.

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

When is a Cyclic Citrullinated Peptide IgG Antibody test ordered?

When someone displays indications and symptoms that could be attributable to previously undiagnosed inflammatory arthritis or has been diagnosed with undifferentiated arthritis, a CCP antibody test is usually ordered along with an RF test. When clinical indications and symptoms lead a health practitioner to suspect RA, it may be ordered as a follow-up test following a negative RF test. In most cases, RA affects many joints in a symmetrical pattern. The following are possible signs and symptoms:

  • Painful, heated, swollen joints in the hands and wrists.
  • Pain that affects the neck, shoulds, elbows, hips, knees, and/or feet.
  • In the morning, affected joints are stiff, although this improves over the day.
  • Fatigue
  • Fatigue
  • Underneath the skin, nodules form, especially at the elbows
  • An overall sensation of unwellness

What does a Cyclic Citrullinated Peptide IgG Antibody blood test check for?

Cyclic citrullinated peptide antibodies are autoantibodies directed against cyclic citrullinated peptides produced by the immune system. Anti-CCP antibodies are detected and measured in the blood with this test.

Citrulline is created in the body as a byproduct of the amino acid arginine metabolism. This conversion may occur at a faster rate in joints with rheumatoid arthritis. Citrulline alters the structure of proteins, triggering an immunological response that results in the production of autoantibodies against joint proteins. The CCP antibody test aids in the diagnosis of RA and can help identify persons with the disease's more quickly erosive type.

RA is a chronic, systemic autoimmune disease that affects the hands, foot, and other joints throughout the body, causing inflammation, discomfort, stiffness, and degenerative changes. It can strike anyone at any age, but it commonly strikes between the ages of 40 and 60, with women accounting for roughly 75 percent of those affected. The prognosis and course of RA are both unpredictable. It could take a long time to develop and progress, or it could happen quickly. In some people, it may go into remission, and in others, it may completely disappear. If left untreated, RA can impair a person's life expectancy and render many people unable to work within a few years.

There are a number of treatments available to help reduce the difficulties of RA, but they all hinge on getting a proper diagnosis and starting treatment before severe joint damage occurs. The basic blood test for detecting RA and distinguishing it from other types of arthritis and other inflammatory processes has been rheumatoid factor. However, RF's sensitivity and specificity aren't optimal; it can be negative in persons with RA symptoms but positive in those who don't. According to studies, the CCP antibody test has a sensitivity and specificity that is comparable to or better than RF, and it is more likely to be positive in patients with early RA.

CCP antibody testing, along with RF, is included in the American College of Rheumatology's (ACR) 2010 Rheumatoid Arthritis Classification Criteria for diagnosing rheumatoid arthritis. CCP antibodies can be found in roughly 50-60% of persons with early RA, as early as 3-6 months following the onset of symptoms, according to the ACR. Early detection and diagnosis of RA allows healthcare practitioners to start aggressive treatment early on, reducing complications and tissue damage.

Lab tests often ordered with a Cyclic Citrullinated Peptide IgG Antibody test:

  • Rheumatoid Factor
  • Sed Rate (ESR)
  • C-Reactive Protein
  • ANA

Conditions where a Cyclic Citrullinated Peptide IgG Antibody test is recommended:

  • Rheumatoid Arthritis
  • Autoimmune Disorders

How does my health care provider use a Cyclic Citrullinated Peptide IgG Antibody test?

To help diagnose rheumatoid arthritis and assess the severity and likely course of the disease, a cyclic citrullinated peptide antibody test may be ordered in conjunction with or after a rheumatoid factor test. Inflammatory indicators such as ESR and C-reactive protein may also be tested at this time.

Cyclic citrullinated peptide antibodies are autoantibodies directed against cyclic citrullinated peptides produced by the immune system.

CCP antibody testing may also be conducted to assess the likelihood of RA developing in persons with undifferentiated arthritis, or those who have symptoms that imply RA but do not yet fulfill the American College of Rheumatology's criteria. According to the American College of Rheumatology, roughly 95% of persons with a positive CCP antibody will develop RA in the future. It is critical to discover RA early in order to make informed treatment recommendations.

What do my CCP Antibody test results mean?

When persons with arthritis symptoms test positive for both CCP antibody and RF, they almost certainly have RA and are at risk of developing a more rapidly progressing and severe version of the illness. When patients show clinical indications of RA and are positive for CCP antibody but not RF, or have low levels of both, it is likely that they have early RA or will develop RA in the future.

When people have a positive RF but no CCP antibody, clinical signs and symptoms are more important in evaluating whether they have RA or another inflammatory illness. It is less likely that someone gets RA if they are negative for both CCP antibody and RF. However, it should be noted that RA is a clinical diagnosis that can be made even if autoantibody testing are negative.

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.


Description: The HLA-B27 Antigen test is a blood test that tests for the presence of human leukocyte antigen B27 on the surface of a person’s white blood cells.

Collection Method: Blood Draw

Specimen Type: Whole Blood

Test Preparation: No preparation required

When is an HLA-B27 Antigen test ordered?

When a patient experiences acute or persistent pain and inflammation in the spinal vertebrae, chest, neck, eyes, and/or joints, and the doctor feels the cause is an autoimmune illness linked to the existence of HLA-B27, an HLA-B27 test may be prescribed. When someone has recurrent uveitis, an HLA-B27 test may also be required.

When doctors suspect ankylosing spondylitis however the disease is in its early stages and the vertebrae in the spine have not yet developed the distinctive alterations that would be visible on X-ray, they usually employ the HLA-B27 test result.

What does an HLA-B27 Antigen blood test check for?

On the surface of cells, there is a particular protein called HLA-B27. The gene that produces the HLA-B27 protein is sometimes referred to as HLA-B27. The HLA-B27 test examines whether a person's white blood cells have the HLA-B27 protein on their surface or not.

Human leukocyte antigens are proteins that assist the immune system of the body in recognizing and differentiating between "self" and "nonself" cells. The many antigens found on each person's cell surfaces are encoded by an inherited mix of HLA genes. Each person has a unique HLA combination depending on the presence or absence of each antigen.

Approximately 6% of Americans have the HLA-B27 gene. Autoimmune conditions such ankylosing spondylitis, juvenile rheumatoid arthritis, reactive arthritis, and isolated acute anterior uveitis are more common in those with HLA-B27. Inflammatory bowel disease and a number of other chronic diseases have also been connected to HLA-B27.

Reactive arthritis and ankylosing spondylitis are two chronic, progressive diseases that affect males more frequently than women. The early 30s are the normal age when the first symptoms appear. It can take years for the typical degenerative changes to bones and joints to become obvious on X-rays, and the initial symptoms of these autoimmune illnesses are frequently mild.

  • Pain, inflammation, and a progressively hardening of the spine, neck, and chest are the hallmarks of ankylosing spondylitis.
  • A collection of symptoms known as reactive arthritis include skin rashes, urethral, ocular, and joint inflammation.
  • A type of arthritis that affects children is called juvenile rheumatoid arthritis.
  • Recurrent inflammation of the tissues in one or both eyes is a symptom of anterior uveitis.

There is a higher prevalence of the antigen in those who are affected, despite the fact that HLA-B27 has not been proven to be the cause of any of these ailments. For instance, 80–90% of persons with ankylosing spondylitis are HLA-B27 positive, despite the fact that only 6% of the general population carries this gene.

Lab tests often ordered with an HLA-B27 Antigen test:

  • Sed Rate
  • C-Reactive Protein
  • Rheumatoid Factor
  • HLA Testing

Conditions where an HLA-B27 Antigen test is recommended:

  • Autoimmune Disorders
  • Ankylosing Spondylitis
  • Reactive Arthritis
  • Juvenile Rheumatoid Arthritis

How does my health care provider use an HLA-B27 Antigen test?

The HLA-B27 test is typically requested to support or confirm a suspected diagnosis of reactive arthritis, juvenile rheumatoid arthritis, ankylosing spondylitis, or occasionally anterior uveitis. The HLA-B27 test is non diagnostic, meaning that it cannot be used to provide a firm diagnosis or exclude a condition. The outcome provides additional information and is one piece of evidence that is utilized in conjunction with the assessment of signs, symptoms, and other laboratory tests to confirm or disprove the diagnosis of specific autoimmune illnesses, such as reactive arthritis and ankylosing spondylitis.

A series of tests, including the HLA-B27 test, may be requested to help identify and assess diseases that result in arthritis-like symptoms such chronic joint pain, feeling stiff, and inflammation. Rheumatoid factor testing using either an erythrocyte sedimentation rate or a C-reactive protein may be part of this set of tests. When evaluating a patient with recurrent uveitis that is not brought on by a known disease etiology, HLA-B27 may occasionally be requested.

What do my HLA-B27 test results mean?

A positive HLA-B27 test indicates that the subject is more likely to acquire specific autoimmune illnesses. Ankylosing spondylitis, arthritis, or another autoimmune illness linked to the presence of HLA-B27 may be diagnosed if the patient exhibits symptoms including chronic pain, inflammation, and/or degenerative changes to the bones. This is particularly true if the individual is young, male, and had his initial symptoms before to the age of 40.

A negative HLA-B27 test indicates that the marker was not found. However, as people without the HLA-B27 antigen can also develop various autoimmune disorders, this does not necessarily imply that the person who was tested does not have the suspected condition. The HLA-B27 antigen carries no guarantee that a person will experience any of these ailments. Researchers are attempting to identify the causes of these specific diseases as well as the variables that increase the risk of these diseases in people with HLA-B27.

Genetics determines whether or not specific HLA antigens will be present. The generation of those antigens is governed by genes that are passed down from parents to their offspring. Two HLA-B27 positive family members who experience the onset of one of the HLA-B27-related illnesses are more likely to experience the onset of the illness themselves.

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.


Description: A CBC or Complete Blood Count with Differential and Platelets test is a blood test that measures many important features of your blood’s red and white blood cells and platelets. A Complete Blood Count can be used to evaluate your overall health and detect a wide variety of conditions such as infection, anemia, and leukemia. It also looks at other important aspects of your blood health such as hemoglobin, which carries oxygen. 

Also Known As: CBC test, Complete Blood Count Test, Total Blood Count Test, CBC with Differential and Platelets test, Hemogram test  

Collection Method: Blood Draw 

Specimen Type: Whole Blood 

Test Preparation: No preparation required 

When is a Complete Blood Count test ordered?  

The complete blood count (CBC) is an extremely common test. When people go to the doctor for a standard checkup or blood work, they often get a CBC. Suppose a person is healthy and their results are within normal ranges. In that case, they may not need another CBC unless their health condition changes, or their healthcare professional believes it is necessary. 

When a person exhibits a variety of signs and symptoms that could be connected to blood cell abnormalities, a CBC may be done. A health practitioner may request a CBC to help diagnose and determine the severity of lethargy or weakness, as well as infection, inflammation, bruises, or bleeding. 

When a person is diagnosed with a disease that affects blood cells, a CBC is frequently done regularly to keep track of their progress. Similarly, if someone is being treated for a blood condition, a CBC may be performed on a regular basis to see if the treatment is working. 

Chemotherapy, for example, can influence the generation of cells in the bone marrow. Some drugs can lower WBC counts in the long run. To monitor various medication regimens, a CBC may be required on a regular basis. 

What does a Complete Blood Count test check for? 

The complete blood count (CBC) is a blood test that determines the number of cells in circulation. White blood cells (WBCs), red blood cells (RBCs), and platelets (PLTs) are three types of cells suspended in a fluid called plasma. They are largely created and matured in the bone marrow and are released into the bloodstream when needed under normal circumstances. 

A CBC is mainly performed with an automated machine that measures a variety of factors, including the number of cells present in a person's blood sample. The findings of a CBC can reveal not only the quantity of different cell types but also the physical properties of some of the cells. 

Significant differences in one or more blood cell populations may suggest the presence of one or more diseases. Other tests are frequently performed to assist in determining the reason for aberrant results. This frequently necessitates visual confirmation via a microscope examination of a blood smear. A skilled laboratory technician can assess the appearance and physical features of blood cells, such as size, shape, and color, and note any anomalies. Any extra information is taken note of and communicated to the healthcare provider. This information provides the health care provider with further information about the cause of abnormal CBC results. 

The CBC focuses on three different types of cells: 

WBCs (White Blood Cells) 

The body uses five different types of WBCs, also known as leukocytes, to keep itself healthy and battle infections and other types of harm. The five different leukocytes are eosinophiles, lymphocytes, neutrophiles, basophils, and monocytes. They are found in relatively steady numbers in the blood. Depending on what is going on in the body, these values may momentarily rise or fall. An infection, for example, can cause the body to manufacture more neutrophils in order to combat bacterial infection. The amount of eosinophils in the body may increase as a result of allergies. A viral infection may cause an increase in lymphocyte production. Abnormal (immature or mature) white cells multiply fast in certain illness situations, such as leukemia, raising the WBC count. 

RBCs (Red Blood Cells) 

The bone marrow produces red blood cells, also known as erythrocytes, which are transferred into the bloodstream after maturing. Hemoglobin, a protein that distributes oxygen throughout the body, is found in these cells. Because RBCs have a 120-day lifespan, the bone marrow must constantly manufacture new RBCs to replace those that have aged and disintegrated or have been lost due to hemorrhage. A variety of diseases, including those that cause severe bleeding, can alter the creation of new RBCs and their longevity. 

The CBC measures the number of RBCs and hemoglobin in the blood, as well as the proportion of RBCs in the blood (hematocrit), and if the RBC population appears to be normal. RBCs are generally homogeneous in size and shape, with only minor differences; however, considerable variances can arise in illnesses including vitamin B12 and folate inadequacy, iron deficiency, and a range of other ailments. Anemia occurs when the concentration of red blood cells and/or the amount of hemoglobin in the blood falls below normal, resulting in symptoms such as weariness and weakness. In a far smaller percentage of cases, there may be an excess of RBCs in the blood (erythrocytosis or polycythemia). This might obstruct the flow of blood through the tiny veins and arteries in extreme circumstances. 

Platelets 

Platelets, also known as thrombocytes, are small cell fragments that aid in the regular clotting of blood. A person with insufficient platelets is more likely to experience excessive bleeding and bruises. Excess platelets can induce excessive clotting or excessive bleeding if the platelets are not operating properly. The platelet count and size are determined by the CBC. 

Lab tests often ordered with a Complete Blood Count test: 

  • Reticulocytes
  • Iron and Total Iron Binding Capacity
  • Basic Metabolic Panel
  • Comprehensive Metabolic Panel
  • Lipid Panel
  • Vitamin B12 and Folate
  • Prothrombin with INR and Partial Thromboplastin Times
  • Sed Rate (ESR)
  • C-Reactive Protein
  • Epstein-Barr Virus
  • Von Willebrand Factor Antigen

Conditions where a Complete Blood Count test is recommended: 

  • Anemia
  • Aplastic Anemia
  • Iron Deficiency Anemia
  • Vitamin B12 and Folate Deficiency
  • Sickle Cell Anemia
  • Heart Disease
  • Thalassemia
  • Leukemia
  • Autoimmune Disorders
  • Cancer
  • Bleeding Disorders
  • Inflammation
  • Epstein-Barr Virus
  • Mononucleosis

Commonly Asked Questions: 

How does my health care provider use a Complete Blood Count test? 

The complete blood count (CBC) is a common, comprehensive screening test used to measure a person's overall health status.  

What do my Complete Blood Count results mean? 

A low Red Blood Cell Count, also known as anemia, could be due many different causes such as chronic bleeding, a bone marrow disorder, and nutritional deficiency just to name a few. A high Red Blood Cell Count, also known as polycythemia, could be due to several conditions including lung disease, dehydration, and smoking. Both Hemoglobin and Hematocrit tend to reflect Red Blood Cell Count results, so if your Red Blood Cell Count is low, your Hematocrit and Hemoglobin will likely also be low. Results should be discussed with your health care provider who can provide interpretation of your results and determine the appropriate next steps or lab tests to further investigate your health. 

What do my Differential results mean? 

A low White Blood Cell count or low WBC count, also known as leukopenia, could be due to a number of different disorders including autoimmune issues, severe infection, and lymphoma. A high White Blood Cell count, or high WBC count, also known as leukocytosis, can also be due to many different disorders including infection, leukemia, and inflammation. Abnormal levels in your White Blood Cell Count will be reflected in one or more of your different white blood cells. Knowing which white blood cell types are affected will help your healthcare provider narrow down the issue. Results should be discussed with your health care provider who can provide interpretation of your results and determine the appropriate next steps or lab tests to further investigate your health. 

What do my Platelet results mean? 

A low Platelet Count, also known as thrombocytopenia, could be due to a number of different disorders including autoimmune issues, viral infection, and leukemia. A high Platelet Count, also known as Thrombocytosis, can also be due to many different disorders including cancer, iron deficiency, and rheumatoid arthritis. Results should be discussed with your health care provider who can provide interpretation of your results and determine the appropriate next steps or lab tests to further investigate your health. 

NOTE: Only measurable biomarkers will be reported. Certain biomarkers do not appear in healthy individuals. 

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.

Reflex Parameters for Manual Slide Review
  Less than  Greater Than 
WBC  1.5 x 10^3  30.0 x 10^3 
Hemoglobin  7.0 g/dL  19.0 g/dL 
Hematocrit  None  75%
Platelet  100 x 10^3  800 x 10^3 
MCV  70 fL  115 fL 
MCH  22 pg  37 pg 
MCHC  29 g/dL  36.5 g/dL 
RBC  None  8.00 x 10^6 
RDW  None  21.5
Relative Neutrophil %  1% or ABNC <500  None 
Relative Lymphocyte %  1% 70%
Relative Monocyte %  None  25%
Eosinophil  None  35%
Basophil  None  3.50%
     
Platelet  <75 with no flags,
>100 and <130 with platelet clump flag present,
>1000 
Instrument Flags Variant lymphs, blasts,
immature neutrophils,  nRBC’s, abnormal platelets,
giant platelets, potential interference
     
The automated differential averages 6000+ cells. If none of the above parameters are met, the results are released without manual review.
CBC Reflex Pathway

Step 1 - The slide review is performed by qualified Laboratory staff and includes:

  • Confirmation of differential percentages
  • WBC and platelet estimates, when needed
  • Full review of RBC morphology
  • Comments for toxic changes, RBC inclusions, abnormal lymphs, and other
  • significant findings
  • If the differential percentages agree with the automated counts and no abnormal cells are seen, the automated differential is reported with appropriate comments

Step 2 - The slide review is performed by qualified Laboratory staff and includes: If any of the following are seen on the slide review, Laboratory staff will perform a manual differential:

  • Immature, abnormal, or toxic cells
  • nRBC’s
  • Disagreement with automated differential
  • Atypical/abnormal RBC morphology
  • Any RBC inclusions

Step 3 If any of the following are seen on the manual differential, a Pathologist will review the slide:

  • WBC<1,500 with abnormal cells noted
  • Blasts/immature cells, hairy cell lymphs, or megakaryocytes
  • New abnormal lymphocytes or monocytes
  • Variant or atypical lymphs >15%
  • Blood parasites
  • RBC morphology with 3+ spherocytes, RBC inclusions, suspect Hgb-C,
  • crystals, Pappenheimer bodies or bizarre morphology
  • nRBC’s

Description: A Comprehensive Metabolic Panel or CMP is a blood test that is a combination of a Basic Metabolic Panel, a Liver Panel, and electrolyte panel, and is used to screen for, diagnose, and monitor a variety of conditions and diseases such as liver disease, diabetes, and kidney disease. 

Also Known As: CMP, Chem, Chem-14, Chem-12, Chem-21, Chemistry Panel, Chem Panel, Chem Screen, Chemistry Screen, SMA 12, SMA 20, SMA 21, SMAC, Chem test

Collection Method: 

Blood Draw 

Specimen Type: 

Serum 

Test Preparation: 

9-12 hours fasting is preferred. 

When is a Comprehensive Metabolic Panel test ordered:  

A CMP is frequently requested as part of a lab test for a medical evaluation or yearly physical. A CMP test consists of many different tests that give healthcare providers a range of information about your health, including liver and kidney function, electrolyte balance, and blood sugar levels. To confirm or rule out a suspected diagnosis, abnormal test results are frequently followed up with other tests that provide a more in depth or targeted analysis of key areas that need investigating. 

What does a Comprehensive Metabolic Panel blood test check for? 

The complete metabolic panel (CMP) is a set of 20 tests that provides critical information to a healthcare professional about a person's current metabolic status, check for liver or kidney disease, electrolyte and acid/base balance, and blood glucose and blood protein levels. Abnormal results, particularly when they are combined, can suggest a problem that needs to be addressed. 

The following tests are included in the CMP: 

  • Albumin: this is a measure of Albumin levels in your blood. Albumin is a protein made by the liver that is responsible for many vital roles including transporting nutrients throughout the body and preventing fluid from leaking out of blood vessels. 

  • Albumin/Globulin Ratio: this is a ratio between your total Albumin and Globulin  

  • Alkaline Phosphatase: this is a measure of Alkaline phosphatase or ALP in your blood. Alkaline phosphatase is a protein found in all body tissues, however the ALP found in blood comes from the liver and bones. Elevated levels are often associated with liver damage, gallbladder disease, or bone disorder. 

  • Alt: this is a measure of Alanine transaminase or ALT in your blood. Alanine Aminotransferase is an enzyme found in the highest amounts in the liver with small amounts in the heart and muscles. Elevated levels are often associated with liver damage. 

  • AST: this is a measure of Aspartate Aminotransferase or AST. Aspartate Aminotransferase is an enzyme found mostly in the heart and liver, with smaller amounts in the kidney and muscles. Elevated levels are often associated with liver damage. 

  • Bilirubin, Total: this is a measure of bilirubin in your blood. Bilirubin is an orange-yellowish waste product produced from the breakdown of heme which is a component of hemoglobin found in red blood cells. The liver is responsible for removal of bilirubin from the body. 

  • Bun/Creatinine Ratio: this is a ratio between your Urea Nitrogen (BUN) result and Creatinine result.  

  • Calcium: this is a measurement of calcium in your blood. Calcium is the most abundant and one of the most important minerals in the body as it essential for proper nerve, muscle, and heart function. 

  • Calcium: is used for blood clot formation and the formation and maintenance of bones and teeth. 

  • Carbon Dioxide: this is a measure of carbon dioxide in your blood. Carbon dioxide is a negatively charged electrolyte that works with other electrolytes such as chloride, potassium, and sodium to regulate the body’s acid-base balance and fluid levels.  

  • Chloride: this is a measure of Chloride in your blood. Chloride is a negatively charged electrolyte that works with other electrolytes such as potassium and sodium to regulate the body’s acid-base balance and fluid levels. 

  • Creatinine: this is a measure of Creatinine levels in your blood. Creatinine is created from the breakdown of creatine in your muscles and is removed from your body by the kidneys. Elevated creatinine levels are often associated with kidney damage. 

  • Egfr African American: this is a measure of how well your kidneys are functioning. Glomeruli are tiny filters in your kidneys that filter out waste products from your blood for removal while retaining important substances such as nutrients and blood cells. 

  • Egfr Non-Afr. American: this is a measure of how well your kidneys are functioning. Glomeruli are tiny filters in your kidneys that filter out waste products from your blood for removal while retaining important substances such as nutrients and blood cells. 

  • Globulin: this is a measure of all blood proteins in your blood that are not albumin. 

  • Glucose: this is a measure of glucose in your blood. Glucose is created from the breakdown of carbohydrates during digestion and is the body’s primary source of energy. 

  • Potassium: this is a measure of Potassium in your blood. Potassium is an electrolyte that plays a vital role in cell metabolism, nerve and muscle function, and transport of nutrients into cells and removal of wastes products out of cells. 

  • Protein, Total: this is a measure of total protein levels in your blood. 
    Sodium: this is a measure of Sodium in your blood. Sodium is an electrolyte that plays a vital role in nerve and muscle function. 

  • Sodium: this is a measure of sodium in your blood's serum. Sodium is a vital mineral for nerve and muscle cell function.

  • Urea Nitrogen (Bun): this is a measure of Urea Nitrogen in your blood, also known as Blood UreaNitrogen (BUN). Urea is a waste product created in the liver when proteins are broken down into amino acids. Elevated levels are often associated with kidney damage. 

Lab tests often ordered with a Comprehensive Metabolic Panel test: 

  • Complete Blood Count with Differential and Platelets
  • Iron and Total Iron Binding Capacity
  • Lipid Panel
  • Vitamin B12 and Folate
  • Prothrombin with INR and Partial Thromboplastin Times
  • Sed Rate (ESR)
  • C-Reactive Protein

Conditions where a Comprehensive Metabolic Panel test is recommended: 

  • Diabetes
  • Kidney Disease
  • Liver Disease
  • Hypertension

Commonly Asked Questions: 

How does my health care provider use a Comprehensive Metabolic Panel test? 

The comprehensive metabolic panel (CMP) is a broad screening tool for assessing organ function and detecting diseases like diabetes, liver disease, and kidney disease. The CMP test may also be requested to monitor known disorders such as hypertension and to check for any renal or liver-related side effects in persons taking specific drugs. If a health practitioner wants to follow two or more separate CMP components, the full CMP might be ordered because it contains more information. 

What do my Comprehensive Metabolic Panel test results mean? 

The results of the tests included in the CMP are usually analyzed together to look for patterns. A single abnormal test result may indicate something different than a series of abnormal test findings. A high result on one of the liver enzyme tests, for example, is not the same as a high result on several liver enzyme tests. 

Several sets of CMPs, frequently performed on various days, may be examined to gain insights into the underlying disease and response to treatment, especially in hospitalized patients. 

Out-of-range findings for any of the CMP tests can be caused by a variety of illnesses, including kidney failure, breathing issues, and diabetes-related complications, to name a few. If any of the results are abnormal, one or more follow-up tests are usually ordered to help determine the reason and/or establish a diagnosis. 

Is there anything else I should know? 

A wide range of prescription and over-the-counter medications can have an impact on the results of the CMP's components. Any medications you're taking should be disclosed to your healthcare professional. Similarly, it is critical to provide a thorough history because many other circumstances can influence how your results are interpreted. 

What's the difference between the CMP and the BMP tests, and why would my doctor choose one over the other? 

The CMP consists of 14 tests, while the basic metabolic panel (BMP) is a subset of those with eight tests. The liver (ALP, ALT, AST, and bilirubin) and protein (albumin and total protein) tests are not included. If a healthcare provider wants a more thorough picture of a person's organ function or to check for specific illnesses like diabetes or liver or kidney disease, he or she may prescribe a CMP rather than a BMP. 

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.

Please note the following regarding BUN/Creatinine ratio: 

The lab does not report the calculation for the BUN/Creatinine Ratio unless one or both biomarkers’ results fall out of the published range. 

If you still wish to see the value, it's easy to calculate. Simply take your Urea Nitrogen (BUN) result and divide it by your Creatinine result.  

As an example, if your Urea Nitrogen result is 11 and your Creatinine result is 0.86, then you would divide 11 by 0.86 and get a BUN/Creatinine Ratio result of 12.79. 


Description: Sed Rate is a blood test that is used to measure the rate that red blood cells fall to the bottom of a test tube. The measurement is based how many cells fall within one hour. This test can be used to determine infection or inflammation.

Also Known As: Erythrocyte Sedimentation Rate Test, ESR Test, Sed Rate Test, Sedimentation Rate Test, Westergren Sedimentation Rate Test

Collection Method: Blood Draw

Specimen Type: Whole Blood

Test Preparation: No preparation required

When is a Sed Rate test ordered?

When a condition or disease is believed to be causing inflammation in the body, an ESR may be ordered. Several inflammatory illnesses can be identified using this test. It may be requested, for example, if arthritis is suspected of producing joint inflammation and pain, or if inflammatory bowel disease is suspected of causing digestive symptoms.

When a person develops symptoms of polymyalgia rheumatica, systemic vasculitis, or temporal arteritis, such as headaches, neck or shoulder discomfort, anemia, pelvic pain, poor appetite, joint stiffness, and unexplained weight loss, a doctor may recommend an ESR. To follow the development of specific illnesses, the sed rate test can also be routinely ordered.

A health practitioner may wish to repeat the ESR before undertaking a full workup to look for disease.

What does a Sed Rate blood test check for?

The erythrocyte sedimentation rate is a test that evaluates the degree of inflammation in the body indirectly. The test evaluates the rate at which erythrocytes fall in a blood sample that has been placed in a tall, thin, vertical tube. The millimeters of clear fluid present at the upper portion of the tube after one hour are reported as the results.

When a drop of blood is inserted in a tube, the red blood cells settle out slowly, leaving just a small amount of transparent plasma. In the presence of an increased number of proteins, particularly proteins known as acute phase reactants, red cells settle at a faster pace. Inflammation raises the levels of acute phase reactants such as C-reactive protein and fibrinogen in the blood.

An inherent component of the immune system's response is inflammation. It could be chronic, showing symptoms over time with conditions like autoimmune illnesses or cancer, or acute, showing symptoms right away after a shock, injury, or infection.

The ESR is a non-specific indication that can rise in a number of disorders; it is not a diagnostic test. It provides you with a fundamental understanding of whether you have an inflammatory condition or not.

Given the availability of more recent, specialized tests, there have been reservations about the ESR's utility. The ESR test, on the other hand, is commonly used to diagnose and monitor temporal arteritis, systemic vasculitis, and polymyalgia rheumatica. Extremely high ESR values can aid in differentiating between rheumatic diseases. Furthermore, ESR may still be a viable alternative in some cases, such as when newer tests are unavailable in resource-constrained places or while monitoring the progression of a disease.

Lab tests often ordered with a Sed Rate test:

  • C-Reactive Protein
  • ANA
  • Rheumatoid Factor

Conditions where a Sed Rate test is recommended:

  • Vasculitis
  • Autoimmune Disorders
  • Rheumatoid Arthritis
  • Osteoarthritis
  • Celiac Disease
  • Lupus
  • Chronic Fatigue Syndrome
  • Juvenile Rheumatoid Arthritis
  • Inflammatory Bowel Disease

How does my health care provider use a Sed Rate test?

The erythrocyte sedimentation rate is a non-specific, very straightforward test that has been used for many years to detect inflammation associated with infections, malignancies, and autoimmune illnesses.

Because an elevated ESR often indicates the presence of inflammation, but does not tell the health practitioner where the inflammation is in the body or what is causing it, it is referred to as a non-specific test. Other illnesses besides inflammation may have an impact on an ESR. As a result, other tests, such C-reactive protein, are routinely paired with the ESR.

ESR is used to identify temporal arteritis, systemic vasculitis, and polymyalgia rheumatica, among other inflammatory illnesses. A notably elevated ESR is one of the crucial test results used to support the diagnosis.

This test can be used to track disease activity and treatment response in both of the disorders mentioned above, as well as several others including systemic lupus erythematosus.

What do my Sed Rate test results mean?

Because ESR is a non-specific inflammatory measure that is influenced by a variety of circumstances, it must be used in conjunction with other clinical findings, the individual's medical history, and the results of other laboratory tests. The health practitioner may be able to confirm or rule out a suspected illness if the ESR and clinical data match.

Without any signs of a specific condition, a single elevated ESR is usually insufficient to make a medical conclusion. A normal result does not, however, rule out inflammation or illness.

Inflammation, as well as anemia, infection, pregnancy, and aging, can cause a moderately raised ESR.

A severe infection with a rise in globulins, polymyalgia rheumatica, or temporal arteritis are common causes of an extremely high ESR. Depending on the person's symptoms, a health practitioner may employ various follow-up tests, such as blood cultures. Even if there is no inflammation, people with multiple myeloma or Waldenstrom's macroglobulinemia have extraordinarily high ESRs.

Rising ESRs may suggest increased inflammation or a poor response to therapy when monitoring a condition over time; normal or falling ESRs may indicate an adequate response to treatment.

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.



Cardiolipin antibodies (CA) are seen in a subgroup of patients with autoimmune disorders, particularly Systemic Lupus Erythematosus (SLE), who are at risk for vascular thrombosis, thrombocytopenia, cerebral infarct and/or recurrent spontaneous abortion. Elevations of CA associated with increased risk have also been seen in idiopathic thrombocytopenic purpura, rheumatoid and psoriatic arthritis, and primary Sjögren's syndrome.

Cardiolipin antibodies (CA) are seen in a subgroup of patients with autoimmune disorders, particularly Systemic Lupus Erythematosus (SLE), who are at risk for vascular thrombosis, thrombocytopenia, cerebral infarct and/or recurrent spontaneous abortion. Elevations of CA associated with increased risk have also been seen in idiopathic thrombocytopenic purpura, rheumatoid and psoriatic arthritis, and primary Sjögren's syndrome.

Cardiolipin antibodies (CA) are seen in a subgroup of patients with autoimmune disorders, particularly Systemic Lupus Erythematosus (SLE), who are at risk for vascular thrombosis, thrombocytopenia, cerebral infarct and/or recurrent spontaneous abortion. Elevations of CA associated with increased risk have also been seen in idiopathic thrombocytopenic purpura, rheumatoid and psoriatic arthritis and primary Sjögren's syndrome.

Description: The CH50 blood test is a screening test used to measure total complement activity in your blood’s serum.

Also Known As: CH50 Test, Total Complement Test, Complement Activity Test, Total Complement Activity Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

When is a Complement Total test ordered?

When a person exhibits inexplicable edema, inflammation, or indications of an autoimmune condition like SLE, complement testing may be mandated. It may also be requested when a medical professional wants to assess the complement system of a patient who they suspect may have an immune complex-related disease.

When the total complement activity is abnormal, individual complement components may be ordered to help identify which ones are lacking or defective.

Complement testing may be used to provide a general assessment of the severity of an acute or chronic ailment after a diagnosis, with the underlying supposition that the severity is related to the decline in complement levels. Occasionally, a doctor may also request complement testing to keep track of the progression of a problem.

What does a Complement Total blood test check for?

Over 30 blood proteins make up the intricate complement system, which functions to support inflammatory and immunological responses. Its main function is to eliminate invading infections like viruses and bacteria. The body's production of antibodies against its own tissues, which occurs in autoimmune disorders, can also cause the complement system to become active. The amount or activity of complement proteins in the blood is measured by complement assays.

A component of the body's innate immune system is the complement system. The innate immune system is non-specific and rapid to react to external molecules, in contrast to the acquired immune system, which generates antibodies that target and defend against specific threats. It does not require prior exposure to an invasive drug or bacterium and does not keep track of prior interactions.

The primary complement proteins are numbered C1 through C9. There are nine of them. Together with the remaining proteins, these elements produce complexes that react to infections, non-self tissues, dead cells, or inflammation by activating, amplifying, breaking apart, and generating complexes.

Lab tests often ordered with a Complement Total test:

  • Sed Rate
  • C-Reactive Protein
  • Rheumatoid Factor
  • ANA Screen
  • Antibody Screen

Conditions where a Complement Total test is recommended:

  • Liver Disease
  • Glomerulonephritis
  • Rheumatoid Arthritis
  • Hemolytic Anemia
  • Systemic Lupus Erythematosis
  • Bacterial Endocarditis
  • Leukemia
  • Hodgkin’s Disease
  • Sarcoma
  • Behcet’s Disease

How does my health care provider use a Complement Total test?

When a person has a disease or illness, complement tests are done to evaluate whether deficiencies or abnormalities in the complement system are the root cause or a contributing factor. In order to assess the overall integrity of the classical complement pathway, total complement activity may be ordered. To check for deficits, additional complement components are obtained if necessary.

What do my Complement Total test results mean?

It's possible for complement levels to drop as a result of greater intake or, less frequently, a congenital deficiency. A high incidence of recurrent microbial infections is typically caused by a hereditary defect in one of the complement proteins. Reduced complement levels are linked to a higher risk of autoimmune disease development.

Complement levels will typically return to normal if the underlying acute or chronic ailment can be treated if the deficiency is brought on by one of these.

During acute or chronic inflammation, complement protein levels typically rise together with those of other unrelated proteins known as acute phase reactants. When the underlying illness is treated, all of these often return to normal. Comparatively to the frequently ordered C-reactive protein (CRP), complement proteins are less frequently assessed in these circumstances; hence, the value of their testing in these circumstances is not discussed here.

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.


Description: A blood culture test is a blood used to identify illness causing bacteria and fungus in a patients blood.

Also Known As: Blood Culture Test, Blood Fungus Test, Blood Bacteria Test, Bacterial Blood Test, Fungal Blood Test, Blood Fungi Test, Sepsis Test

Collection Method: Blood Draw

Specimen Type: Whole Blood

Test Preparation: No preparation required

Important: Aerobic culture, anaerobic culture. If culture is positive, identification will be performed at an additional charge (CPT code(s): 87076 or 87106 or 87077 or 87140 or 87143 or 87147 or 87149).
Antibiotic susceptibilities are only performed when appropriate (CPT code(s): 87181 or 87184 or 87185 or 87186).

When is a Blood Culture test ordered?

When a patient exhibits sepsis symptoms, which show that bacteria, fungus, or their toxic byproducts are harming the body, a healthcare professional may order blood cultures.

Drawing blood cultures might be suitable when symptoms are present in patients who are at a higher risk of developing a systemic infection due to previous infections, surgeries, prosthetic heart valve replacements, or immunosuppressive medication. Blood cultures are taken more frequently from babies and young children since they may have an infection but not always display the classic sepsis symptoms.

What does a Blood Culture test check for?

Blood cultures are techniques used to find the source of an illness in the blood and detect it. Although viruses, yeasts, and other fungi as well as bacteria can potentially cause bloodstream infections, they are less prevalent. This article concentrates on the use of blood cultures to find and identify bacteria and fungus in the blood, though blood can also be used to test for viruses.

When a person has a serious infection and/or the immune system is unable to contain it at its source, a blood infection often develops from another specific spot within the body. For instance, a urinary tract infection may spread from the bladder and/or kidneys into the circulation, travel throughout the body, infect other organs, and result in a serious and occasionally fatal systemic infection. Sometimes, the terms septicemia and sepsis are used synonymously to refer to this condition. While sepsis is the body's acute, overpowering, and occasionally lethal response to infection, septicemia refers to an infection of the blood. This ailment frequently need for quick and vigorous care, usually in a hospital's critical care unit.

The infection of the blood can lead to more severe consequences. A bloodstream infection may lead to endocarditis, an inflammation and infection of the heart's lining and/or heart valves. Although these infections are uncommon, patients with artificial heart valves or joints are more likely to develop systemic infections after surgery.

Blood infections are more common in people whose immune systems are compromised by underlying illnesses like leukemia or HIV/AIDS or by immunosuppressive medications used in chemotherapy. These people are more likely to contract blood infections because their immune systems are less able to destroy the microorganisms that occasionally enter the blood. Through the use of intravenous drugs, intravenous catheters, or surgical drains, bacteria and yeasts can also enter the circulation directly.

Before they are declared as negative, blood cultures are cultured for a number of days. If originally present in low numbers, some species of bacteria and fungi may develop more slowly than others and/or take longer to be discovered.

A blood culture that is positive identifies the exact bacteria that is infecting the patient, and susceptibility testing is done to determine which drugs are most likely to be helpful in treating the illness.

The blood culture testing procedure is automated, and devices continuously check the samples for bacterial or fungal development. This enables prompt results reporting and enables the medical professional to target antimicrobial medication specifically at the particular bacteria found in the blood. While awaiting the results of a blood culture, broad-spectrum antimicrobials are typically administered intravenously because therapy must be started as soon as feasible in situations of sepsis. Once the bacteria responsible for the infection is discovered, antimicrobial medication may be switched out for a more focused antibiotic therapy.

Lab Tests often ordered with a Blood Culture test:

  • Complete Blood Count (CBC)
  • Urine Culture
  • Susceptibility Testing

Conditions where a Blood Culture test is recommended:

  • Urinary Tract Infection
  • Skin Infection
  • Meningitis
  • Pneumonia
  • Encephalitis
  • Sepsis
  • Fungal Infection
  • Staph Infection
  • Septic Arthritis
  • Food and Waterborne Illness

How is this test used by my health care provider?

Blood cultures are used to determine the type of bacteria or fungi present, detect their presence in the blood, and direct treatment. A blood infection that can cause sepsis, a dangerous and potentially fatal consequence, is detected by testing. Testing is frequently carried out in a hospital setting because patients with suspected blood infections are frequently treated in intensive care units.

This article concentrates on the use of blood cultures to identify and detect bacteria and fungus, while blood samples may be used to detect viruses as well.

Additional related tests that might be carried out include:

Gram stain, a fast test for determining the sort of bacteria in question,

Testing for susceptibility identifies the medication that might be most successful at treating the infection.

The blood culture is frequently followed by a request for a complete blood count to see if the patient has an elevated white blood cell count, a sign of a possible infection. Sometimes additional testing is carried out, such as a chemistry panel to assess an individual's organ condition or a urine culture to assist in determining the origin of the initial illness. This is especially true if a person exhibits signs of a meningitis, pneumonia, or urinary tract infection.

What do my Blood Culture test results mean?

The presence of the same bacteria or fungi in two or more blood cultures indicates that the person being examined most likely has a blood infection with that microbe. The exact bacteria or fungi that are causing the infection are usually identified in the results.

Blood infections are dangerous conditions that require prompt treatment, frequently in a hospital. Sepsis is a complication that poses a serious risk to life, particularly in those with compromised immune systems. While awaiting the results of the blood culture or susceptibility testing, medical professionals who suspect sepsis may start patients on intravenous broad spectrum antibiotics that are efficient against a variety of bacteria. A more targeted antimicrobial agent for the bacteria or fungi found in the blood cultures may be used as treatment once the results are available.

A skin contaminant or infection may be present if one blood culture set is positive and the other is negative. Before making a diagnosis, the medical professional will take into account the patient's clinical condition and the type of bacteria or fungi discovered. In this instance, more testing might also be necessary.

After several days, blood culture sets that are negative indicate that there is a low likelihood that the patient has a blood illness brought on by bacteria or fungi. Additional testing, however, might be necessary if symptoms linger, including a fever that won't go away. Symptoms may persist despite negative blood culture results for a number of reasons, including

It may be necessary to perform additional blood cultures using specialized nutrient media in order to attempt and grow and identify the pathogen because some microorganisms are more difficult to grow in culture.

Blood culture bottles made to grow bacteria cannot be used to detect viruses. Additional laboratory testing would need to be carried out if the medical professional believes that the patient's symptoms could be due to a viral infection. Depending on the patient's clinical symptoms and the type of virus the doctor believes is the cause of the illness, certain tests may be prescribed.

Even though blood cultures are negative, sepsis may still be present based on the results of further tests that may be performed in conjunction with blood cultures. Some of them could be:

  • thorough blood count. An infection may be indicated by an elevated white blood cell count.
  • Complement. The concentration of C3 can rise.
  • An infection source that may have moved to the blood may be identified by a positive urine or sputum culture.

An examination of the CSF could point to the infection's origin.

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.


Description: The Lyme disease antibody test is testing for Borrelia antibodies. Borrelia is the bacteria that causes Lyme Disease. The immune system produces antibodies to fight against the infection of Borrelia, or Lyme disease.

Also Known As: Borrelia burgdorferi Test, Lyme Disease Antibodies IgG IgM Immunoblot Test, Lyme Disease antibodies Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

When is a Lyme Disease Antibodies test ordered?

When a person shows signs and symptoms of Borrelia infection and lives in or has visited a place where deer ticks, also known as black-legged ticks, are abundant, especially if the person has recently been bitten by a tick, Lyme disease testing is required.

Testing may be repeated after a few weeks if initial testing is negative but the suspicion of Lyme disease remains strong.

When a person does not have typical Lyme disease symptoms or a history of tick bites, and has not traveled to a Lyme disease-endemic area, a healthcare provider may rule out alternative possibilities before diagnosing and testing for Lyme disease.

What does a Lyme Disease Antibodies blood test check for?

The bacteria Borrelia burgdorferi and Borrelia mayonii, which are transported predominantly by the deer tick, often known as the black-legged tick, cause Lyme disease. Borrelia antibodies in the blood are measured in Lyme disease tests.

The body’s immune system produces these antibodies in reaction to exposure to Borrelia, the organism that causes Lyme disease. Infected deer ticks or black-legged ticks bite humans and transfer the bacterium. In areas where these ticks reside, such as the northeastern, mid-Atlantic, and midwestern United States, the disease is most common in the spring and summer.

A distinctive erythema migrans or “bulls-eye” rash that develops from the bite site, fever, chills, headache, and exhaustion are all indications of Lyme disease infection. Lyme disease can progress to cause intermittent joint pain and swelling, facial paralysis, weakening and numbness in the arms and legs, meningitis, memory issues, and in rare cases, heart and vision problems if left untreated.

It takes time for the immune system to produce antibodies against Borrelia. Two types of antibodies can be detected using laboratory tests. IgM antibodies are normally evident two to three weeks after the commencement of infection, while IgG antibodies are seen several weeks later.

Lab tests often ordered with a Lyme Disease Antibodies test:

  • Babesia Microti Antibodies
  • Bartonella Species Antibodies
  • Ehrlichia Chaffeensis Antibodies
  • Epstein-Barr Virus Antibody Panel

Conditions where a a Lyme Disease Antibodies test is recommended:

  • Lyme Disease

How does my health care provider use a Lyme Disease Antibodies test?

Lyme disease tests are performed to see if a person has been infected with the germs Borrelia burgdorferi or Borrelia mayonii and has the symptoms of the disease. Antibodies generated by the immune system in response to infection are detected by the tests.

IgM and IgG antibodies can be detected via laboratory tests.

Antibodies to Borrelia IgM are frequently present in the blood two to three weeks after exposure. IgM concentrations peak about six weeks and then start to drop.

IgG antibodies are not detectable for many weeks after exposure, peak at four to six months, and can last for several years.

To identify these antibodies and confirm a diagnosis of Lyme disease, the CDC recommends using two alternative procedures. The initial test is designed to be extremely sensitive in order to detect as many Lyme disease cases as possible. When a person does not have Lyme disease but does have another condition, such as another tick-borne disease, syphilis, or an autoimmune ailment like lupus, it may be positive. If the initial test yields a positive result, a second test using a different method is done to validate the findings. 

Lyme disease can be difficult to diagnose at times. If a person has removed a tick from his or her skin, has had a known tick bite, and lives in or has visited an area of the country where Lyme disease is common, the timing of the probable infection can be accurately predicted. However, because the tick is about the size of a pinhead, the bite may go unnoticed. Not everyone will get the rash, and the symptoms that do occur may be nonspecific and flu-like in the beginning, with joint pain that progresses to chronic arthritis and/or neurological problems that appear months later.

What do my Lyme Disease antibodies test results mean?

Antibodies are not produced in a healthy adult who has never been infected with Borrelia germs.

If a person exhibits signs and symptoms, as well as positive EIA or IFA and western blot tests, it is likely that they have Lyme disease.

If a person tests positive for IgM antibody but negative for IgG and western blot, they may have had a recent infection or a false-positive test result.

If an IgM result is undetectable but the IgG and Western blot tests are positive, the person examined is likely to have a later stage infection or to have had an infection previously.

If all tests come out negative, the person's symptoms are either caused by something else or the antibody levels are too low to detect at that time; retesting in 2 to 3 weeks may be required to confirm or rule out infection.

If the IgM and western blot are negative but the IgG is positive, the person has either recovered from Lyme disease or the symptoms are due to cross reactive antibodies plus something else.

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.


The major proteins seen in the serum are albumin and globulin-the latter being primarily alpha 1 and alpha 2 globulin, beta globulin and gamma globulin. Albumin accounts for more than 50% of the total serum proteins. The albumin to globulin (A/G) ratio has been used as an index of disease state, however, it is not a specific marker for disease because it does not indicate which specific proteins are altered. The normal A/G ratio is 0.8-2.0. The A/G ratio can be decreased in response to a low albumin or to elevated globulins. Total globulins may be increased in some chronic inflammatory diseases (TB, syphilis) multiple myeloma, collagen disease, and rheumatoid arthritis. Decreased levels are seen in hepatic dysfunction, renal disease and various neoplasms.

Salicylates are used in the treatment of fever, analgesia and in the treatment of acute rheumatic fever, rheumatoid arthritis and for inhibition of platelet aggregation in patients with CAD. When treating rheumatoid arthritis, salicylates reduce the inflammation in joint tissues. Salicylate levels are monitored to assess toxicity.

Includes

6-Thioguanine (6-TG), 6-Methylmercaptopurine (6-MMP)

Patient Preparation 

trough specimen is required (within 1 hour prior to the next dose)

Reference Range(s)

 

6-TG 235-400 pmol/8x10(8) RBC
6-MMP <5700 pmol/8x10(8) RBC

 

Clinical Significance

6-Mercaptopurine (Purinethol) and its imidazolyl derivative, Azathioprine (Imuran), are immunosuppressive drugs. 6-Mercaptopurine (6-MP) is indicated for remission induction and maintenance therapy of acute lymphoblastic leukemia (ALL). Azathioprine is indicated as an adjunct for the prevention of rejection in renal allograft (kidney transplant) patients, for the management of rheumatoid arthritis, and for the management of inflammatory bowel disease.
Azathioprine is cleaved to 6-MP. 6-MP is metabolized via a series of enzymatic steps to 6-thioguanine nucleotides (6-TGNs), to 6-methyl-mercaptopurine (6-MMPNs) by the enzyme thiopurine methyltransferase (TPMT), and to 6-thiouric acid by the enzyme xanthine oxidase (XO). TPMT enzyme activity has large inter-individual variations which affect the efficacy, toxicity and variability of the treatment. Therapeutic drug monitoring of 6-MP metabolites (6-TGNs and 6-MMPNs) in erythrocytes is recommended to assist therapy, particularly in combination with TPMT enzyme activity or mutation analysis.



Juvenile Rheumatoid Arthritis (JRA) affects children under 16. It is an idiopathic disease with unknown causes. Arthritis is a disease in which the tendons and tissues of the body are badly affected by germs and viruses. It is an autoimmune disorder disease in which the immune system is damaged. White blood cells increase, and red blood cells decrease. The virus starts eating the tendons and tissues of the body without distinction, causing pain to parts of the body. The most affected parts are the joints which become stiff, painful, inflamed, and red.

JRA is the most common type of arthritis and affects more than 50,000 young adolescents in the United States.

Types 

There are six types of JRA:

Pauciarticular or Oligoarthritis

It affects four joints or fewer, affecting about half of the patients suffering from JRA. It targets knees, wrists, and eyes.

Polyarticular

It affects more than five joints and targets smaller joints such as those in the hands. It is classified into rheumatoid factor (RF)-negative, which affects girls more than boys, and RF-positive, which has similar symptoms to adult rheumatoid arthritis.

Systematic

This type of JRA targets the entire body, including joints, skin, and internal organs. Most affected patients experience a sharp increase in fever and frequent rashes.

Psoriatic Arthritis

This is when unusual redness occurs on sensitive areas such as near the ears, eyelids, elbows, knees, belly button, and skin of the head. It may affect one or two organs.

Spondylarthritis

It is also known as enthesis-related arthritis and affects the muscles, ligaments, or tendons attached to the bones and usually targets the hips, knees and elbows, lower limbs, and digestive tract. This type of JRA is more common in children between 8-15 years.

Undeferential Arthritis

Symptoms of this type of JRA don’t match up perfectly with any of the subtypes.

Causes

No specific cause has been found so far. Some scientists believe that it runs in families, and some put emphasis on stressful environmental triggers such as trauma, stress, tension, and depression, which accelerate this disease. It has been established that the child’s defense system, which fights against viruses and germs (autoimmune system), must be seriously disturbed for the disease to occur. In JRA, the white blood cells (WBC) which fight against viruses start destroying the healthy red blood cells indiscriminately, resulting in increased WBCs and decreased RBCs.

Symptoms and Risks 

JRA patients complain of mild, moderate, and acute pain in joints. When affected children wake up in the morning or after a nap, they experience stiffness in their limbs, and they can’t stand without pain. The patient limps and resumes normal walking. The patient’s joints, large organs, mouth, jaw, tongue, fingers, wrists, cervical region, and lymph nodes swell with severe rashes on the body. This delays the child’s growth; their bones get thinner and weaker and might be more prone to breaking. Some patients feel sleepy, drowsy, and exhausted. Children suffering from JRA can also experience glaucoma, cataract, dry eyes, inflammation, redness, sensitivity to light, and vision problems.

JRA also manifests as inflammation in the lungs and heart. This causes shortness of breath, further damage to the organs, and disturbance of the digestive system with symptoms such as indigestion, diarrhea, and pain. JRA may lead to infertility and weight loss or gain.

JRA is diagnosed when symptoms persist for at least six weeks. This is confirmed with clinical exams and laboratory tests.

Benefits and Types of Laboratory Tests 

The following information will make it easier to learn about the many benefits of the different types of lab tests used to screen, diagnose, and monitor the condition.

Antinuclear Antibody (ANA)

This lab test is used to find out if there is any presence of autoantibodies. Almost 80% of patients showing symptoms related to eye diseases test positive for this test, and it has positive results for most children affected by JRA.

Rheumatoid Factor (RF)

The results of this test are dependent on the type of JRA the patient has.

Erythrocyte Sedimentation Rate (ESR) or C-reactive Protein (CRP)

Both laboratory tests are used to find the presence and level of inflammation in the patient’s body.

Complete Blood Count (CBC)

This is used to determine the red and white blood cell count as well as the patient’s hemoglobin level. This helps diagnose conditions such as anemia associated with the inflammation due to JRA.

Comprehensive Metabolic Panel (CMP)

As JRA can also affect the child’s kidneys and liver, this test is necessary to monitor the function of these vital organs. A vital step in diagnosing JRA is eliminating other similar conditions.

HLA-B27

This test helps differentiate between the types of arthritis.

Synovial Fluid Analysis

This detects any crystals that might be present in the joint and determines if there is any joint inflammation.

Types of Non-Laboratory Tests

  • X-rays can detect joint inflammation, fluid build-up, fractures, tumors, or infections, etc.
  • A thorough eye exam is necessary to monitor any eye inflammation.
  • An EKG can identify any heart inflammation.

Treatment

Although juvenile rheumatoid arthritis is incurable, a combination of treatments effectively alleviates pain or prevents bone damage. This treatment includes:

  • Medication
  • Surgery
  • Physiotherapy
  • Chiropractic therapy (massage, swimming, exercise, joint support, or use of splints to protect joints)
  • Occupational therapy
  • Psychotherapies (cognitive behavior therapy, REBT, and other modern approaches)
  • Alternative therapies
  • Diet control
  • Hot massages (to soothe joint inflammation) or use of cold elements (to numb organs)
  • Acceptance of the severity of the disease and help in applying positive thinking techniques to provide physical and mental comfort to the patient.

In short, interdisciplinary approaches need to be used to reduce the pain and suffering that accompanies JRA. Strong family support and positivity of the patient’s peer group play a vital role as well for the patient to respond to the medication.


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