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Test Name

Rheumatoid Arthritis Diagnostic IdentRA® Panel 4 (New)

CPT Code(s)

86200, 86235 (x2), 83520 (x4)

Includes

Rheumatoid Factor (IgA, IgG, IgM), Cyclic Citrullinated Peptide (CCP) Antibody (IgG), Sjögren's Antibodies (SS-A, SS-B), 14-3-3 eta Protein*

Methodology

See individual tests

Reference Range(s)

See individual tests

Clinical Significance

RF is present in 75% of adult RA patients with the highest incidence of RF occurring in persons over 65 years of age. Increased RF levels may also accompany a variety of acute immune responses, particularly viral infections and a number of other diseases (infectious mononucleosis, tuberculosis, leprosy, various parasitic diseases, liver disease, sarcoidosis and systemic lupus erythematosus). Recently, it has become apparent that the specificity and predictive value of the RF test is substantially increased by the detection of all three RF isotypes. Studies suggest that the detection of RF IgA in early disease indicates poor prognosis and justifies a more aggressive course of treatment. In addition to RF IgM, raised levels of RF IgA and IgG have been reported in patients with RA.
Anti-SS-A/SS-B antibodies can be detected in about 6% of patients affected by RA. These patients present a peculiar clinical picture characterized by extra-articular manifestations some of which are known to be Sjogren's Ab correlated.
Early diagnosis of rheumatoid arthritis (RA), i.e., diagnosis before significant joint erosion occurs, is difficult. Psoriatic arthritis can also be difficult to diagnose clinically early in the disease process, and there are no specific biomarkers. The 14-3-3eta protein is an emerging biomarker for RA and erosive psoriatic arthritis diagnosis. It may play a biologic role in the joint erosive process. Blood levels appear to be elevated in patients with RA, but not in other diseases including psoriasis, osteoporosis, gout, ulcerative colitis, type 1 diabetes, systemic lupus erythematosus, Crohn disease, primary Sjogren syndrome, scleroderma, and multiple sclerosis. The 14-3-3eta protein, used in conjunction with rheumatoid factor (RF) and cyclic citrullinated peptide (CCP) antibody, may improve diagnostic sensitivity in the early diagnosis of RA. It may also help differentiate those psoriasis patients with psoriatic arthritis erosive joint damage from those without joint damage.

Alternative Name(s)

IdentRA®,RA Panel 4

To view specimen requirements and codes please Select a regional laboratory.

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Reference ranges are provided as general guidance only. To interpret test results use the reference range in the laboratory report.

The CPT codes provided are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payer being billed.

* The tests listed by specialist are a select group of tests offered. For a complete list of Quest Diagnostics tests, please refer to our Directory of Services.

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Rheumatoid Arthritis Diagnostic IdentRA® Panel 4
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