Institute of Immunology, Technical University Dresden, Germany.
Autoimmun Rev. 2010 Apr;9(6):431-5. doi: 10.1016/j.autrev.2009.11.017. Epub 2009 Nov 28.
An increasing number of rheumatoid arthritis (RA)-associated autoantibodies (AAB) are available for AAB profiling that may improve the early diagnosis of RA and provide prognostic and, probably theranostic information. To select AAB specificities for optimal AAB combinations, known AAB should be evaluated with standardized methods by means of standardized study designs and subjected to statistical analysis. Profiling of anti-citrullinated peptide/protein antibodies (ACPA), anti-A2/RA-33 antibodies, and rheumatoid factors (RF) IgM and IgA improves the serologic diagnosis of RA using cut-offs corresponding to 98% specificity for each parameter included. Currently, the combination of anti-CCP antibodies with RF IgM and RF IgA is recommended either in parallel or by stepwise determination. Because anti-CCP antibody demonstrated the best diagnostic performance for profiling, this AAB should be used for first-line screening. The main advantage of AAB profiling is the increased sensitivity for RA diagnosis. Additional benefits of AAB profiles comprise the increased diagnostic specificity of particular AAB combinations (e.g., ACPA plus RF or RF IgM plus RF IgA) and their possible association with disease development and/or therapy response. The inclusion of novel RA-associated AAB (RAAB) and use of clinically evaluated multiplex assays may facilitate the use of profiling in diagnostic routine laboratories.
越来越多的类风湿关节炎 (RA) 相关自身抗体 (AAB) 可用于 AAB 分析,这可能有助于早期诊断 RA,并提供预后和治疗相关信息。为了选择最佳 AAB 组合的 AAB 特异性,应通过标准化研究设计和统计分析,用标准化方法评估已知的 AAB。使用与每个参数的特异性为 98%对应的截止值,分析抗瓜氨酸化肽/蛋白抗体 (ACPA)、抗 A2/RA-33 抗体和类风湿因子 (RF) IgM 和 IgA,可以改善 RA 的血清学诊断。目前,推荐将抗 CCP 抗体与 RF IgM 和 RF IgA 平行或逐步联合检测。由于抗 CCP 抗体在分析中表现出最佳的诊断性能,因此应将其用于一线筛查。AAB 分析的主要优势在于提高 RA 诊断的敏感性。特定 AAB 组合(例如 ACPA 加 RF 或 RF IgM 加 RF IgA)的诊断特异性增加,以及它们与疾病进展和/或治疗反应的可能相关性,是 AAB 分析的其他益处。新型 RA 相关 AAB (RAAB) 的纳入和临床评估的多重检测的使用可能有助于在诊断常规实验室中使用分析。