Which of the following serological diagnostic tests is most specific for rheumatoid arthritis?
A. C-reactive protein (CRP)
B. Rheumatoid factor (RF)
C. Anti-nuclear antibodies (ANA)
D. Anti-citrullinated protein autoantibodies (ACPA)
ANS: D
A variety of laboratory tests are used to diagnose RA, including the rheumatoid factor, which is positive in up to 80% of persons with RA but not specific to this disorder. It is often falsely positive in patients with other diseases, including lupus, sarcoidosis, and syphilis. RA is often associated with normocytic, hypochromic anemia, as well as elevations in sedimentation rate and C-reactive protein. Other laboratory tests that may be positive at diagnosis include antinuclear antibody (ANA) and anticitrullinated protein (anti-CP) autoantibodies. The anti-CP autoantibodies are more specific to RA than the rheumatoid factor. Radiological images show loss of joint space and erosion.
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