Overview

Learn about the clinical benefits of a novel biomarker to aid in the diagnosis of early Rheumatoid Arthritis (RA). New guidelines for the classification of RA have been developed that go beyond Rheumatoid factor. Anti-cyclic citrullinated peptide (CCP IgG) antibody has been added to the criteria and is highly specific for RA. However both RF and CCP have limitations. Both have low sensitivity in early RA. Both can be seronegative in up to 44% of RA patients. A new biomarker, 14-3-3eta, normally an intracellular protein, has been discovered. It is released into the extracellular environment from the inflamed joint in RA and can be detected in a simple blood test. The 14-3-3eta protein test increases identification of early RA patients. This facilitates early treatment of this progressive and debilitating disease.

A positive 14-3-3eta test should trigger a priority rheumatology referral by the primary care physician. Higher levels of 14-3-3eta protein indicate more aggressive disease and significant joint deterioration. With early intervention of biological therapy, decreasing serial measurements of 14-3-3eta protein indicate favorable patient response. Decreasing serial measurements indicate favorable response to biological therapy.



Learning Objectives

  • Recognize rheumatoid arthritis is one of the most prevalent autoimmune diseases with increased co-morbidities and is challenging to diagnose versus osteoarthritis.
  • Describe traditional markers Rheumatoid Factor (RF), CRP, and ESR, systemic markers of inflammation but not highly specific for RA.
  • New criteria added CCP antibody test, specific for RA, in 2010.
  • Learn limitations of CCP antibody and RF in that they can be seronegative in up to one- third of RA patients and are not highly sensitive in early RA.
  • Educate on novel biomarker 14-3-3eta, highly specific for RA and demonstrating greater sensitivity than RF or CCP in early RA. Higher levels indicate more aggressive disease. Decreasing serial measurements indicate favorable response to therapy. Positive 14-3-3eta test should trigger a priority rheumatology referral by the primary care physician.  


Faculty Information

Martin J. Bergman, MD, FACR, FACP, FCPP

Clinical Associate Prof of Medicine
Drexel University College of Medicine
Philadelphia, PA 

Sponsor

Quest Diagnostics