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.

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.

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Elevated RF is found in collagen vascular diseases such as SLE, rheumatoid arthritis, scleroderma, Sjögren's Syndrome, and in other conditions such as leprosy, tuberculosis, syphilis, malignancy, thyroid disease and in a significant percentage of otherwise normal elderly patients.

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.


Antinuclear antibodies are associated with rheumatic diseases including Systemic Lupus Erythematous (SLE), mixed connective tissue disease, Sjogren's syndrome, scleroderma, polymyositis, CREST syndrome, and neurologic SLE. 

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


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


A synthetic circular peptide containing citrulline called CCP IgG (cyclic citrullinated peptide) has been found to be better at discriminating Rheumatoid Arthritis patients from other patients than either the perinuclear autoantibody test or the test for rheumatoid factor. Approximately 70% of patients with Rheumatoid Arthritis are positive for Anti-CCP IgG, while only about 2% of random blood donors and disease controls subjects are positive.

HLA-B27 is found in 90% of patients with ankylosing spondylitis and 80% in Reiter's disease. Ankylosing spondylitis affects 1 in 1000 caucasians. Ankylosing spondylitis is 10 times more common among individuals with HLA-B27 compared to individuals without this antigen.

A Complete Blood Count (CBC) Panel is used as a screening test for various disease states including anemia, leukemia, and inflammatory processes.

A CBC blood test includes the following biomarkers: WBC, RBC, Hemoglobin, Hematocrit, MCV, MCH, MCHC, RDW, Platelet count, Neutrophils, Lymphs, Monocytes, Eos, Basos, Neutrophils (Absolute), Lymphs (Absolute), Monocytes(Absolute), Eos (Absolute), Basos (Absolute), Immature Granulocytes, Immature Grans (Abs)

NOTE: Only measurable biomarkers will be reported.

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

Comprehensive Metabolic Panel


Useful in differentiating inflammatory and neoplastic diseases and as an index of disease severity. CRP is also useful in monitoring inflammatory disease states.


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.

CH50 is a screening test for total complement activity. Levels of complement may be depressed in genetic deficiency, liver disease, chronic glomerulonephritis, rheumatoid arthritis, hemolytic anemias, graft rejection, systemic lupus erythematosis, acute glomerulonephritis, subacute bacterial endocarditis and cryoglobulinemia. Elevated complement may be found in acute inflammatory conditions, leukemia, Hodgkin's Disease, sarcoma, and Behcet's Disease.

Clinical Significance

Bacterial sepsis constitutes one of the most serious infectious diseases. The detection of microorganisms in a patient's blood has importance in the diagnosis and prognosis of endocarditis, septicemia, or chronic bacteremia.

Includes

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).


Lyme disease is transmitted by a tick vector carrying Borrelia burgdorferi. Immunoblot testing qualitatively examines, with high specificity, antibodies in a patient's specimen. Immunoblot testing is appropriate for confirming a detected EIA or IFA test result.

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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