Rheumatoid Arthritis (RA) Expanded Profile

CPT: 85652; 86140; 86200; 86431
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Test Details

Test Includes

C-Reactive protein, quantitative; cyclic citrullinated peptide antibodies, IgA, IgG; rheumatoid arthritis factor; sedimentation rate (modified Westergren)

Use

According to the American College of Rheumatology 2010 Classification Criteria for Rheumatoid Arthritis, "measurements of Rheumatoid Arthritis Factor (RF), anti-CCP, ESR, and CRP are included as a part of the diagnostic algorithm. To classify a patient as having or not having definite RA, a history of symptom duration, a thorough joint evaluation, and at least 1 serologic test (RF or anti-CCP) and 1 acute-phase response measure (ESR or CRP) must be obtained."1

Limitations

Markedly lipemic or contaminated specimens may yield false-positive results. CRP arises as a nonspecific response to tissue injury and inflammation. The ESR is of limited diagnostic value in severe anemia or in hematologic states that affect increased size and shape variation (poikilocytosis) of the RBC (ie, presence of sickle cells or spherocytes). Extreme plasma viscosity will result in a decreased ESR.

Methodology

CRP: Latex immunoturbidimetry; CCP: Enzyme-linked immunosorbent assay; RA Factor: Latex immunoturbidimetry; Sedimentation Rate: Automated and manual methods

Reference Interval

See individual tests.

Additional Information

"It is acknowledged that an individual patient may meet the definition of RA without requiring that all tests be performed. For example, patients with a sufficient number of joints involved and longer duration of symptoms will meet criteria regardless of their serologic or acute-phase response status. The classification criteria can be applied to any patient or otherwise healthy individual, as long as 2 mandatory requirements are met: first, there must be evidence of currently active clinical synovitis (i.e., swelling) in at least 1 joint as determined by an expert assessor. Second, the criteria may be applied only to those patients in whom the observed synovitis is not better explained by another diagnosis."1

Specimen Requirements

Specimen

Serum and whole blood

Minimum Volume

Whole blood: 2 mL and serum: 1.5 mL

Container

Lavender-top (EDTA) tube and gel-barrier tube or red-top tube.

Collection

See individual tests.

Storage Instructions

Refrigerate. Serum is stable for seven days at room temperature, refrigerated, or frozen for 14 days. Freeze/thaw cycles: stable x3. Whole blood: 24 hours

Causes for Rejection

Hemolysis; lipemia; clotted, underfilled tube; specimen older than 24 hours, improper labeling, transport tubes with whole blood, specimen received in any anticoagulant other than EDTA; specimen diluted or contaminated with IV fluid; patient specimen with presence of cold agglutinins or cryoglobulins; specimen received with plasma removed

Clinical Information

Footnotes

1. American College of Rheumatology. The 2010 ACR-EULAR Classification Criteria for Rheumatoid Arthritis. Available at: http://www.rheumatology.org/practice/clinical/classification/ra/ra_2010.asp. Accessed June 20, 2014.

References

Gambino SR, Dire JJ, Monteleone M, et al. The Westergren sedimentation rate using K3 EDTA. Tech Bull Regist Med Technol. 1965; 35:1-8.
Harmening D. Clinical Hematology and Fundamentals of Hemostasis. 2nd ed. Philadelphia, Pa: Lippincott;1992:532-534.

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
164245 RA Expanded Profile 006171 RA Latex Turbid. IU/mL 11572-5
164245 RA Expanded Profile 006627 C-Reactive Protein, Quant mg/L 1988-5
164245 RA Expanded Profile 164915 CCP Antibodies IgG/IgA units 57093-7
164245 RA Expanded Profile 005215 Sedimentation Rate-Westergren mm/hr 4537-7

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The LOINC® codes are copyright © 1994-2017, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee. Permission is granted in perpetuity, without payment of license fees or royalties, to use, copy, or distribute the LOINC® codes for any commercial or non-commercial purpose, subject to the terms under the license agreement found at https://loinc.org/license/. Additional information regarding LOINC® codes can be found at LOINC.org, including the LOINC Manual, which can be downloaded at LOINC.org/downloads/files/LOINCManual.pdf