El laboratorio en las enfermedades reumáticas autoinmunes

  • José Fernando Molina Restrepo CES. Clínica Las Américas.
Palabras clave: enfermedades reumáticas autoinmunes, clínica, diagnóstico, laboratorio.

Resumen

Las enfermedades reumáticas autoinmunes son un grupo de padecimientos crónicos de etiología desconocida, que pueden compartir manifestaciones clínicas y hallazgos de laboratorio similares, lo cual puede dificultar un diagnóstico acertado para el clínico que se enfrenta por primera vez a este tipo de pacientes. El diagnóstico temprano de las enfermedades reumáticas autoinmunes es de gran importancia y los resultados del laboratorio pueden ser de gran utilidad, siempre y cuando sean interpretados en el contexto clínico del paciente. Es bien conocido que un diagnóstico y un tratamiento tempranos conllevan a una disminución de la morbilidad y mortalidad en los pacientes reumáticos. Las enfermedades reumáticas autoinmunes generalmente se caracterizan por la producción de reactantes de fase aguda y de autoanticuerpos que reconocen una gama variada de antígenos nucleares y citoplasmáticos, los cuales ayudan en el diagnóstico diferencial de estos desórdenes, que incluyen la artritis reumatoide, el lupus eritematoso sistémico y el síndrome de Sjögren, entre otros. Este módulo tiene como finalidad guiar al clínico en el proceso de un diagnóstico tem- prano de las principales enfermedades reumáticas autoinmunes, incluyendo su diagnóstico diferencial por el laboratorio.

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Biografía del autor/a

José Fernando Molina Restrepo, CES. Clínica Las Américas.

Médico especialista en Medicina Interna y Reumatología. Profesor Asociado de Reumatología, CES. Clínica Las Américas, Medellín, Colombia.

Referencias bibliográficas

Ramos-Niembro F. Criterios para la clasificación de las enfermedades reumáticas. In Tratado Hispanoamericano de Reumatología, Alarcón-Segovia D, Molina J, Molina JF, Catoggio L, Cardiel MH y Angulo JM. Editorial Nomos S.A., Bogotá, Colombia. 2006; 113- 119.

Orbach H, Gilburd B, Brickman CM, Gerli R, Shoenfeld Y. Anti-cyclic citrullinated peptide antibodies as a diagnostic test for rheumatoid arthritis and predictor of an erosive disease. Isr Med Assoc J 2002; 4: 892-893.

Nielen MM, van Schaardenburg D, Reesink HW, van de Stadt RJ, van der Horst-Bruinsma IE, de Koning MH, et al. Specific autoantibodies precede the symptoms of rheumatoid arthritis: a study of serial measurements in blood donors. Arthritis Rheum 2004; 50: 380-386. https://doi.org/10.1002/art.20018

van Gaalen FA, Linn-Rasker SP, van Venrooij WJ, de Jong BA, Breedveld FC, Verweij CL, et al. Autoantibodies to cyclic citrullinated peptides predict progression to rheumatoid arthritis in patients with undifferentiated arthritis: a prospective cohort study. Arthritis Rheum 2004; 50: 709-715. https://doi.org/10.1002/art.20044

Boers M. Rheumatoid arthritis. Treatment of early disease. Rheum Dis Clin North Am 2001; 27: 405-414. https://doi.org/10.1016/S0889-857X(05)70209-X

Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 1988; 31: 315-324. https://doi.org/10.1002/art.1780310302

Emery P, Breedveld FC, Dougados M, Kalden JR, Schiff MH, Smolen JS. Early referral recommendation for newly diagnosed rheumatoid arthritis: evidence based development of a clinical guide. Ann Rheum Dis 2002; 61: 290-297. https://doi.org/10.1136/ard.61.4.290

van der Heijde DM. Joint erosions and patients with early rheumatoid arthritis. Br J Rheumatol 1995; 34 Suppl 2: 74-78. https://doi.org/10.1093/rheumatology/XXXIV.suppl_2.74

Anderson JJ, Wells G, Verhoeven AC, Felson DT. Factors predicting response to treatment in rheumatoid arthritis: the importance of disease duration. Arthritis Rheum 2000; 43: 22-29. https://doi.org/10.1002/1529-0131(200001)43:1<22::AID-ANR4>3.0.CO;2-9

Kim JM, Weisman MH. When does rheumatoid arthritis begin and why do we need to know? Arthritis Rheum 2000; 43: 473- 484. https://doi.org/10.1002/1529-0131(200003)43:3<473::AID-ANR1>3.0.CO;2-A

Kroot EJ, van Leeuwen MA, van Rijswijk MH, Prevoo ML, Van ‹t Hof MA, van De Putte LB, et al. No increased mortality in patients with rheumatoid arthritis: up to 10 years of follow up from disease onset. Ann Rheum Dis 2000; 59: 954-958. https://doi.org/10.1136/ard.59.12.954

Molina J, Molina JF. Lupus eritematoso sistémico. In Texto de Reumatología, Fundamentos de Medicina (CIB), Molina J, Alarcón- Segovia D, Molina JF, Anaya JM y Cardiel MH. 6a edición, CIB, Medellín, Colombia. 2005; 201-223

Tan EM, Cohen AS, Fries JF, Masi AT, McShane DJ, Rothfield NF, et al. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1982; 25: 1271-1277. https://doi.org/10.1002/art.1780251101

Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1997; 40: 1725. https://doi.org/10.1002/art.1780400928

Carsons S. A review and update of Sjögren›s syndrome: manifestations, diagnosis, and treatment. Am J Manag Care 2001; 7: S433-443.

Anaya JM, Correa P. Síndrome de Sjögren. In Texto de Reumatología, Fundamentos de Medicina (CIB), Molina J, Alarcón-Segovia D, Molina JF, Anaya JM y Cardiel MH. 6a edición, CIB, Medellín, Colombia. 2005; 264-273.

Fox RI. Sjögren›s syndrome. Lancet 2005; 366: 321-331. https://doi.org/10.1016/S0140-6736(05)66990-5

Skopouli FN, Drosos AA, Papaioannou T, Moutsopoulos HM. Preliminary diagnostic criteria for Sjögren›s syndrome. Scand J Rheumatol Suppl 1986; 61: 22-25.

Vitali C, Bombardieri S, Moutsopoulos HM, Balestrieri G, Bencivelli W, Bernstein RM, et al. Preliminary criteria for the classification of Sjögren›s syndrome. Results of a prospective concerted action supported by the European Community. Arthritis Rheum 1993; 36: 340-347. https://doi.org/10.1002/art.1780360309

Vitali C, Bombardieri S, Jonsson R, Moutsopoulos HM, Alexander EL, Carsons SE, et al. Classification criteria for Sjögren ́s syndrome: a revised version of the European criteria proposed by the American-European Consensus Group. Ann Rheum Dis 2002; 61: 554-558. https://doi.org/10.1136/ard.61.6.554

Medsger TA, Jr. Natural history of systemic sclerosis and the assessment of disease activity, severity, functional status, and psychologic well-being. Rheum Dis Clin North Am 2003; 29: 255-273. https://doi.org/10.1016/S0889-857X(03)00023-1

Piera-Velásquez S, Derk C, Jiménez S. Esclerosis sistémica: Etiopatogenia. In Tratado Hispanoamericano de Reumatología, Alarcón-Segovia D, Molina J, Molina JF, Catoggio L, Cardiel MH y Angulo JM. Editorial Nomos S.A., Bogotá, Colombia. 2006; 885-895.

Lyons R, Narain S, Nichols C, Satoh M, Reeves WH. Effective use of autoantibody tests in the diagnosis of systemic autoimmune disease. Ann N Y Acad Sci 2005; 1050: 217-228. https://doi.org/10.1196/annals.1313.023

Chung L, Lin J, Furst DE, Fiorentino D. Systemic and localized scleroderma. Clin Dermatol 2006; 24: 374-392. https://doi.org/10.1016/j.clindermatol.2006.07.004

Steen VD. Autoantibodies in systemic sclerosis. Semin Arthritis Rheum 2005; 35: 35-42. https://doi.org/10.1016/j.semarthrit.2005.03.005

Mastaglia FL, Phillips BA. Idiopathic inflammatory myopathies: epidemiology, classification, and diagnostic criteria. Rheum Dis Clin North Am 2002; 28: 723-741. https://doi.org/10.1016/S0889-857X(02)00021-2

Bohan A, Peter JB. Polymyositis and dermatomyositis (first of two parts). N Engl J Med 1975; 292: 344-347. https://doi.org/10.1056/NEJM197502132920706

Bohan A, Peter JB. Polymyositis and dermatomyositis (second of two parts). N Engl J Med 1975; 292: 403-407. https://doi.org/10.1056/NEJM197502202920807

Dalakas MC, Sivakumar K. The immunopathologic and inflammatory differences between dermatomyositis, polymyositis and sporadic inclusion body myositis. Curr Opin Neurol 1996; 9: 235-239. https://doi.org/10.1097/00019052-199606000-00015

Miller FW. Classification and prognosis of inflammatory muscle disease. Rheum Dis Clin North Am 1994; 20: 811-826. https://doi.org/10.1016/S0889-857X(21)00067-3

Tanimoto K, Nakano K, Kano S, Mori S, Ueki H, Nishitani H, et al. Classification criteria for polymyositis and dermatomyositis. J Rheumatol 1995; 22: 668-674. https://doi.org/10.1525/ae.1995.22.3.02a00680

Love LA, Leff RL, Fraser DD, Targoff IN, Dalakas M, Plotz PH, et al. A new approach to the classification of idiopathic inflammatory myopathy: myositis-specific autoantibodies define useful homogeneous patient groups. Medicine (Baltimore) 1991; 70: 360-374. https://doi.org/10.1097/00005792-199111000-00002

Fries JF, Hochberg MC, Medsger TA, Jr., Hunder GG, Bombardier C. Criteria for rheumatic disease. Different types and different functions. The American College of Rheumatology Diagnostic and Therapeutic Criteria Committee. Arthritis Rheum 1994; 37: 454-462. https://doi.org/10.1002/art.1780370403

Campuzano-Maya G. Uso y utilidad clínica de la eritrosedimentación. Medicina & Laboratorio 2000; 9: 311-345.

Miller A, Green M, Robinson D. Simple rule for calculating normal erythrocyte sedimentation rate. Br Med J (Clin Res Ed) 1983; 286: 266. https://doi.org/10.1136/bmj.286.6361.266

Molina J, Bedoya AM, Márquez J. Laboratorio en enfermedades reumáticas. In Tratado Hispanoamericano de Reumatología, Alarcón-Segovia D, Molina J, Molina JF, Catoggio L, Cardiel MH y Angulo JM. Editorial Nomos S.A., Bogotá, Colombia. 2006; 189- 202

Brigden ML. Clinical utility of the erythrocyte sedimentation rate. Am Fam Physician 1999; 60: 1443-1450.

Shmerling RH. Diagnostic tests for rheumatic disease: clinical utility revisited. South Med J 2005; 98: 704-711. https://doi.org/10.1097/01.smj.0000171073.07875.c5

Brigden M. The erythrocyte sedimentation rate. Still a helpful test when used judiciously. Postgrad Med 1998; 103: 257-262, 272-254. https://doi.org/10.3810/pgm.1998.05.493

Tillett WS FT. Serological reactions in pneumonia with a non-protein somatic fraction of the pneumococcus J Exp Med 1930; 52: 561-571. https://doi.org/10.1084/jem.52.4.561

Volanakis JE. Human C-reactive protein: expression, structure, and function. Mol Immunol 2001; 38: 189-197. https://doi.org/10.1016/S0161-5890(01)00042-6

Pannacciulli N, Cantatore FP, Minenna A, Bellacicco M, Giorgino R, De Pergola G. C-reactive protein is independently associated with total body fat, central fat, and insulin resistance in adult women. Int J Obes Relat Metab Disord 2001; 25: 1416-1420. https://doi.org/10.1038/sj.ijo.0801719

Albert MA, Glynn RJ, Buring J, Ridker PM. C-reactive protein levels among women of various ethnic groups living in the United States (from the Women›s Health Study). Am J Cardiol 2004; 93: 1238-1242. https://doi.org/10.1016/j.amjcard.2004.01.067

Kahn SE, Zinman B, Haffner SM, O›Neill MC, Kravitz BG, Yu D, et al. Obesity is a major determinant of the association of C-reactive protein levels and the metabolic syndrome in type 2 diabetes. Diabetes 2006; 55: 2357-2364. https://doi.org/10.2337/db06-0116

Spoorenberg A, van der Heijde D, de Klerk E, Dougados M, de Vlam K, Mielants H, et al. Relative value of erythrocyte sedimentation rate and C-reactive protein in assessment of disease activity in ankylosing spondylitis. J Rheumatol 1999; 26: 980- 984.

Wolfe F. Comparative usefulness of C-reactive protein and erythrocyte sedimentation rate in patients with rheumatoid arthritis. J Rheumatol 1997; 24: 1477-1485.

ter Borg EJ, Horst G, Limburg PC, van Rijswijk MH, Kallenberg CG. C-reactive protein levels during disease exacerbations and infections in systemic lupus erythematosus: a prospective longitudinal study. J Rheumatol 1990; 17: 1642-1648.

Haverkate F, Thompson SG, Pyke SD, Gallimore JR, Pepys MB. Production of C-reactive protein and risk of coronary events in stable and unstable angina. European Concerted Action on Thrombosis and Disabilities Angina Pectoris Study Group. Lancet 1997; 349: 462-466. https://doi.org/10.1016/S0140-6736(96)07591-5

Clearfield MB. C-reactive protein: a new risk assessment tool for cardiovascular disease. J Am Osteopath Assoc 2005; 105: 409-416.

Munujos P. Diagnóstico por el laboratorio de las enfermedades reumáticas. Medicina & Laboratorio 2000; 9: 439-460.

Shmerling RH, Delbanco TL. The rheumatoid factor: an analysis of clinical utility. Am J Med 1991; 91: 528-534. https://doi.org/10.1016/0002-9343(91)90190-9

Renaudineau Y, Jamin C, Saraux A, Youinou P. Rheumatoid factor on a daily basis. Autoimmunity 2005; 38: 11-16. https://doi.org/10.1080/08916930400022574

Lee DM, Schur PH. Clinical utility of the anti-CCP assay in patients with rheumatic diseases. Ann Rheum Dis 2003; 62: 870- 874. https://doi.org/10.1136/ard.62.9.870

Mimori T. Clinical significance of anti-CCP antibodies in rheumatoid arthritis. Intern Med 2005; 44: 1122-1126. https://doi.org/10.2169/internalmedicine.44.1122

López-Hoyos M, Ruíz de Alegría C, Blanco R, Crespo J, Pena M, Rodríguez-Valverde V, et al. Clinical utility of anti-CCP antibodies in the differential diagnosis of elderly-onset rheumatoid arthritis and polymyalgia rheumatica. Rheumatology (Oxford) 2004; 43: 655-657. https://doi.org/10.1093/rheumatology/keh143

Bombardieri M, Alessandri C, Labbadia G, Iannuccelli C, Carlucci F, Riccieri V, et al. Role of anti-cyclic citrullinated peptide antibodies in discriminating patients with rheumatoid arthritis from patients with chronic hepatitis C infection-associated polyarticular involvement. Arthritis Res Ther 2004; 6: R137-141. https://doi.org/10.1186/ar1041

Tobón GJ, Correa PA, Anaya-Cabrrera JM. Anticuerpos anti-péptido citrulinado cíclico: un nuevo marcador en artritis reumatoide. Medicina & Laboratorio 2005; 11: 79-90.

Kavanaugh A, Tomar R, Reveille J, Solomon DH, Homburger HA. Guidelines for clinical use of the antinuclear antibody test and tests for specific autoantibodies to nuclear antigens. American College of Pathologists. Arch Pathol Lab Med 2000; 124: 71-81. https://doi.org/10.5858/2000-124-0071-GFCUOT

Arbuckle MR, McClain MT, Rubertone MV, Scofield RH, Dennis GJ, James JA, et al. Development of autoantibodies before the clinical onset of systemic lupus erythematosus. N Engl J Med 2003; 349: 1526-1533. https://doi.org/10.1056/NEJMoa021933

Tan EM, Feltkamp TE, Smolen JS, Butcher B, Dawkins R, Fritzler MJ, et al. Range of antinuclear antibodies in «healthy» individuals. Arthritis Rheum 1997; 40: 1601-1611. https://doi.org/10.1002/art.1780400909

Riboldi P, Gerosa M, Moroni G, Radice A, Allegri F, Sinico A, et al. Anti-DNA antibodies: a diagnostic and prognostic tool for systemic lupus erythematosus? Autoimmunity 2005; 38: 39-45. https://doi.org/10.1080/08916930400022616

Kurien BT, Scofield RH. Autoantibody determination in the diagnosis of systemic lupus erythematosus. Scand J Immunol 2006; 64: 227-235. https://doi.org/10.1111/j.1365-3083.2006.01819.x

Kramers C, Hylkema MN, van Bruggen MC, van de Lagemaat R, Dijkman HB, Assmann KJ, et al. Anti-nucleosome antibodies complexed to nucleosomal antigens show anti-DNA reactivity and bind to rat glomerular basement membrane in vivo. J Clin Invest 1994; 94: 568-577. https://doi.org/10.1172/JCI117371

Franceschini F, Cavazzana I. Anti-Ro/SSA and La/SSB antibodies. Autoimmunity 2005; 38: 55-63. https://doi.org/10.1080/08916930400022954

Damoiseaux JG, Tervaert JW. From ANA to ENA: how to proceed? Autoimmun Rev 2006; 5: 10-17. https://doi.org/10.1016/j.autrev.2005.05.007

Migliorini P, Baldini C, Rocchi V, Bombardieri S. Anti-Sm and anti-RNP antibodies. Autoimmunity 2005; 38: 47-54. https://doi.org/10.1080/08916930400022715

Harley JB, Scofield RH, Reichlin M. Anti-Ro in Sjögren›s syndrome and systemic lupus erythematosus. Rheum Dis Clin North Am 1992; 18: 337-358. https://doi.org/10.1016/S0889-857X(21)00731-6

Cómo citar
1.
Molina Restrepo JF. El laboratorio en las enfermedades reumáticas autoinmunes. Med. Lab. [Internet]. 1 de enero de 2007 [citado 8 de diciembre de 2021];13(1-2):11-3. Disponible en: https://medicinaylaboratorio.com/index.php/myl/article/view/493
Publicado
2007-01-01
Sección
La Clínica y el Laboratorio

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