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Advanced Arthritis Profile

Bone

66 parameters

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Details

Basic arthritis panel (includes ESR, CRP, RF, uric acid).

₹2,999₹3,999

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Parameters

  • List of Tests
    • Calcium
    • Alkaline Phosphatase
    • SGOT
    • SGPT
    • Uric Acid
    • Complement 3 (C3)
    • Anti-Streptolysin (ASO)
    • BUN, Creatinine, BUN/Creatinine
    • GGT
    • RF
    • ANA
    • Anti CCP (ACCP)
    • Iron Studies (Iron, TIBC, Transferrin)
    • Serum Bilirubin (Total, Direct, Indirect)
    • Lipid Profile (Cholesterol/HDL, LDL/HDL, Non-HDL, VLDL, Total Cholesterol, Triglycerides, HDL, LDL)
    • Total Protein, Albumin, Globulin, A/G Ratio
    • Thyroid Profile (Total T3, Total T4, TSH)
    • C-Reactive Protein (CRP)
    • Hba1c, Estimated Average Glucose
    • CBC - Complete Hemogram

Advanced Arthritis Profile

  • Why is it done?
    • Comprehensive diagnosis and assessment of various types of arthritis including rheumatoid arthritis, osteoarthritis, and autoimmune arthropathies
    • Evaluation of inflammatory markers (CRP, Complement 3) to assess disease activity and severity of joint inflammation
    • Detection of specific autoantibodies (RF, ANA, Anti-CCP) that indicate autoimmune-mediated joint disease
    • Assessment of baseline organ function (liver, kidney, thyroid) before initiating immunosuppressive or disease-modifying antirheumatic drugs (DMARDs)
    • Monitoring of metabolic complications in arthritis patients including gout risk (uric acid), anemia, and nutritional status
    • Evaluation of secondary conditions such as systemic lupus erythematosus (SLE), psoriatic arthritis, and seronegative spondyloarthropathies
    • Differential diagnosis among various arthritis subtypes and monitoring therapeutic response to treatment
    • Assessment of systemic manifestations of arthritis including constitutional symptoms, cardiovascular risk, and endocrine abnormalities
  • Normal Range
    • Calcium: 8.5-10.2 mg/dL (2.13-2.55 mmol/L) - Ionized calcium: 4.5-5.3 mg/dL (1.1-1.3 mmol/L)
    • Alkaline Phosphatase: 30-120 IU/L (adults) - varies by age and gender
    • SGOT (AST - Aspartate Aminotransferase): 10-40 IU/L
    • SGPT (ALT - Alanine Aminotransferase): 7-56 IU/L
    • Uric Acid: Male 3.5-7.2 mg/dL, Female 2.6-6.0 mg/dL (0.21-0.43 mmol/L for males, 0.15-0.36 mmol/L for females)
    • Complement 3 (C3): 70-160 mg/dL (0.7-1.6 g/L)
    • Anti-Streptolysin (ASO): <200 IU/mL or negative - varies by laboratory and geographic region
    • BUN (Blood Urea Nitrogen): 7-20 mg/dL (2.5-7.1 mmol/L)
    • Creatinine: Male 0.7-1.3 mg/dL, Female 0.6-1.1 mg/dL (62-115 µmol/L for males, 53-97 µmol/L for females)
    • BUN/Creatinine Ratio: 10-20:1 (normal range indicates adequate renal perfusion)
    • GGT (Gamma-Glutamyl Transferase): Male 0-65 IU/L, Female 0-36 IU/L
    • RF (Rheumatoid Factor): <14 IU/mL or negative - Negative is normal
    • ANA (Antinuclear Antibody): Negative or <1:80 titer - Negative is normal
    • Anti-CCP (Anti-Cyclic Citrullinated Peptide): <20 IU/mL or negative - Negative is normal
    • Iron: Male 60-170 µg/dL, Female 50-170 µg/dL (10.7-30.4 µmol/L for males, 9.0-30.4 µmol/L for females)
    • TIBC (Total Iron Binding Capacity): 250-425 µg/dL (45-72 µmol/L)
    • Transferrin: 204-360 mg/dL (2.0-3.6 g/L)
    • Total Bilirubin: 0.1-1.2 mg/dL (1.7-20.5 µmol/L)
    • Direct Bilirubin: 0.0-0.3 mg/dL (0-5 µmol/L)
    • Indirect Bilirubin: 0.1-0.9 mg/dL (1.7-15.4 µmol/L)
    • Total Cholesterol: <200 mg/dL (<5.18 mmol/L) - desirable
    • HDL (High-Density Lipoprotein): >40 mg/dL (>1.04 mmol/L) for males, >50 mg/dL (>1.30 mmol/L) for females
    • LDL (Low-Density Lipoprotein): <100 mg/dL (<2.59 mmol/L) - optimal
    • Triglycerides: <150 mg/dL (<1.70 mmol/L) - normal
    • VLDL (Very Low-Density Lipoprotein): <30 mg/dL (<0.77 mmol/L)
    • Total Protein: 6.0-8.3 g/dL (60-83 g/L)
    • Albumin: 3.5-5.0 g/dL (35-50 g/L)
    • Globulin: 2.0-3.5 g/dL (20-35 g/L)
    • A/G Ratio (Albumin/Globulin Ratio): 1.0-2.5:1
    • Total T3: 80-200 ng/dL (1.2-3.1 nmol/L)
    • Total T4: 4.5-12.0 µg/dL (58-154 nmol/L)
    • TSH (Thyroid-Stimulating Hormone): 0.4-4.0 mIU/L (0.4-4.0 mU/L)
    • C-Reactive Protein (CRP): <3.0 mg/L - negative, normal
    • HbA1c (Glycated Hemoglobin): <5.7% - normal glucose tolerance
    • Estimated Average Glucose (eAG): <100 mg/dL (<5.6 mmol/L) - normal
    • CBC - Complete Hemogram: Hemoglobin: Male 13.5-17.5 g/dL, Female 12.0-15.5 g/dL; RBC: 4.5-5.9 million/µL (males), 4.1-5.1 million/µL (females); WBC: 4,500-11,000/µL; Platelets: 150,000-400,000/µL; Hematocrit: Male 41-50%, Female 36-44%
  • Interpretation
    • Calcium: Elevated levels may indicate hyperparathyroidism or bone metastases; decreased levels suggest hypoparathyroidism, vitamin D deficiency, or renal disease. In arthritis, abnormal calcium relates to bone mineral density changes
    • Alkaline Phosphatase: Elevated levels indicate bone turnover, liver disease, or recent fractures. In arthritis patients, elevation may reflect active bone remodeling or concurrent osteoporosis
    • SGOT (AST): Elevation may indicate hepatic injury from DMARD therapy, hepatitis, or muscle damage. In arthritis monitoring, elevated AST requires evaluation for medication-related liver toxicity
    • SGPT (ALT): More specific for liver injury than AST. Elevation indicates hepatocellular damage, particularly important in monitoring methotrexate and other immunosuppressive therapies used in RA
    • Uric Acid: Elevated levels (>7.0 mg/dL) indicate hyperuricemia and gout risk. Diuretics commonly used in arthritis management may elevate uric acid, precipitating gout attacks
    • Complement 3 (C3): Decreased levels (<70 mg/dL) indicate active immune complex disease, particularly in SLE and other autoimmune arthropathies. Serial monitoring reflects disease activity
    • Anti-Streptolysin (ASO): Elevated titers (>200 IU/mL) indicate recent group A streptococcal infection, important in post-streptococcal reactive arthritis diagnosis. Four-fold rise between acute and convalescent samples is diagnostic
    • BUN (Blood Urea Nitrogen): Elevated levels indicate renal dysfunction, critical in arthritis patients on NSAIDs and certain DMARDs that affect kidney function. Must be monitored regularly during immunosuppressive therapy
    • Creatinine: Elevated levels indicate renal impairment. Baseline and periodic monitoring essential in arthritis patients, as some biologics and conventional DMARDs can cause nephrotoxicity
    • BUN/Creatinine Ratio: Ratio >20:1 suggests prerenal azotemia (dehydration, reduced renal perfusion); <10:1 indicates intrinsic renal disease or acute tubular necrosis
    • GGT (Gamma-Glutamyl Transferase): Elevation indicates hepatobiliary disease or alcohol consumption. Useful for detecting alcohol-related liver disease in arthritis patients, particularly those on multiple hepatotoxic drugs
    • RF (Rheumatoid Factor): Positive results (>14 IU/mL) indicate seropositive RA and correlate with disease severity, radiographic progression, and extra-articular manifestations. Present in 70-80% of RA patients
    • ANA (Antinuclear Antibody): Positive titers (>1:80) indicate autoimmune disease. Pattern types (homogeneous, speckled, nucleolar, centromeric) help differentiate SLE, SSc, Sjögren's syndrome, and mixed connective tissue disease
    • Anti-CCP (Anti-Cyclic Citrullinated Peptide): Positive results (>20 IU/mL) are highly specific for RA (97% specificity) and predict radiographic progression. Present early in disease, even before RF positivity in 30% of seronegative RA
    • Iron: Elevated levels cause iron overload disease; decreased levels indicate iron deficiency anemia. In arthritis, iron deficiency may result from chronic inflammation and blood loss from GI complications of NSAIDs
    • TIBC (Total Iron Binding Capacity): Elevated TIBC indicates iron deficiency; decreased TIBC suggests iron overload or chronic disease. Assessment of iron utilization capacity is crucial in anemia management
    • Transferrin: Decreased levels indicate iron overload disease; elevated levels suggest iron deficiency. Reflects the body's capacity to transport iron and availability for erythropoiesis
    • Total Bilirubin: Elevation indicates hepatic dysfunction or hemolysis. In arthritis patients on DMARDs or biologics, elevated bilirubin requires assessment for drug-induced liver injury or hemolytic anemia
    • Direct Bilirubin: Elevation indicates cholestasis or hepatic dysfunction; unconjugated hyperbilirubinemia or hemolysis if predominantly elevated indirect bilirubin
    • Indirect Bilirubin: Elevation primarily indicates hemolysis or impaired conjugation capacity, suggesting hemolytic anemia which can complicate autoimmune arthropathies
    • Total Cholesterol: >200 mg/dL is borderline high, >240 mg/dL is high. RA patients have elevated cardiovascular risk, requiring lipid management alongside arthritis treatment
    • HDL (High-Density Lipoprotein): Low HDL indicates increased cardiovascular disease risk. Critical to maintain adequate HDL, particularly in RA patients with elevated atherosclerotic risk from chronic inflammation
    • LDL (Low-Density Lipoprotein): >130 mg/dL is high; <70 mg/dL recommended for high-risk patients. Arthritis patients often require aggressive LDL lowering given inflammatory disease burden
    • Triglycerides: 150-199 mg/dL is borderline high, >200 mg/dL is high. Elevated triglycerides increase cardiovascular risk, particularly in RA with systemic inflammation
    • VLDL (Very Low-Density Lipoprotein): Calculated value; elevation indicates increased triglyceride production and associated cardiovascular risk. Usually calculated as triglycerides divided by 5
    • Total Protein: Low levels indicate malnutrition, malabsorption, or hepatic dysfunction; elevated levels suggest chronic inflammation or dehydration. In arthritis, reflects overall nutritional status and inflammatory burden
    • Albumin: Low levels indicate poor nutritional status, hepatic disease, malabsorption, or chronic illness. Critical indicator in arthritis as chronic inflammation leads to hypoalbuminemia and negative prognostic implications
    • Globulin: Elevation indicates immune response, chronic inflammation, or multiple myeloma. In arthritis, elevated globulins reflect active immune dysregulation and disease activity
    • A/G Ratio: Ratios <1.0 indicate relatively increased globulins suggesting immune activation; ratios >2.5 indicate relatively decreased globulins or increased albumin. In chronic arthritis, ratios tend to favor globulins
    • Total T3: Elevated levels suggest hyperthyroidism; decreased levels indicate hypothyroidism or euthyroid sick syndrome. Important as autoimmune thyroid disease frequently coexists with RA
    • Total T4: Elevated levels indicate hyperthyroidism; decreased levels suggest hypothyroidism. Used alongside TSH to assess thyroid function, critical as thyroid disease affects disease activity
    • TSH (Thyroid-Stimulating Hormone): Elevated TSH indicates primary hypothyroidism; suppressed TSH (<0.1) indicates hyperthyroidism. Most sensitive test for thyroid dysfunction; autoimmune thyroid disease common in RA patients
    • C-Reactive Protein (CRP): >3.0 mg/L indicates inflammation; levels directly correlate with RA disease activity, joint destruction, and systemic manifestations. Serial monitoring essential for treatment efficacy assessment
    • HbA1c (Glycated Hemoglobin): 5.7-6.4% indicates prediabetes; >6.5% indicates diabetes. Chronic inflammation in arthritis increases diabetes risk; monitoring essential particularly in RA patients
    • Estimated Average Glucose (eAG): Derived from HbA1c; 100-125 mg/dL indicates prediabetes, >126 mg/dL indicates diabetes. Provides patient-friendly glucose average over 2-3 months
    • Hemoglobin: Low levels indicate anemia of chronic disease, common in RA and other chronic arthropathies. Elevation may suggest hemoconcentration or polycythemia
    • RBC (Red Blood Cells): Decreased counts indicate anemia; elevated counts suggest polycythemia or hemoconcentration. Essential in arthritis workup as anemia indicates disease severity
    • WBC (White Blood Cells): Decreased counts (<4,500/µL) indicate leukopenia, may result from DMARDs or disease process; elevated counts (>11,000/µL) suggest infection or leukemoid reaction. Critical in DMARD monitoring
    • Platelets: Thrombocytopenia (<150,000/µL) may result from SLE, antiphospholipid syndrome, or DMARD toxicity; thrombocytosis (>400,000/µL) indicates inflammation. Important safety monitoring parameter
    • Hematocrit: Low values indicate anemia; elevated values suggest hemoconcentration or polycythemia. Percentage of red blood cells in blood; serial monitoring tracks anemia progression or improvement
  • Associated Organs
    • Calcium and Alkaline Phosphatase: Assess bone metabolism, skeletal system integrity, and risk for osteoporosis secondary to RA and corticosteroid use. Monitor for bone demineralization complications
    • SGOT, SGPT, GGT, Total Bilirubin: Hepatic function monitoring essential as DMARDs (methotrexate, sulfasalazine, biologics), NSAIDs, and corticosteroids are hepatotoxic. Detect drug-induced liver injury and hepatic complications
    • Uric Acid: Metabolic system indicator; elevated levels precipitate gout (crystal arthropathy). Assessment critical in differentiating polyarticular gout from RA
    • Complement 3, Anti-Streptolysin O: Immune system assessment; abnormal values indicate complement consumption from immune complexes or recent streptococcal infection leading to postinfectious arthritis
    • BUN, Creatinine, BUN/Creatinine Ratio: Renal function assessment critical as NSAIDs, ACE inhibitors, and certain biologics can compromise kidney function. Monitor for drug-induced nephrotoxicity and glomerulonephritis
    • RF, ANA, Anti-CCP: Immune system assessment; specific autoantibodies help diagnose autoimmune arthropathies and differentiate RA from other connective tissue diseases
    • Iron Studies (Iron, TIBC, Transferrin): Assess hematopoietic system and iron metabolism; evaluate for iron deficiency anemia from chronic disease, NSAID-related GI bleeding, or malabsorption
    • Lipid Profile (Cholesterol, HDL, LDL, Triglycerides, VLDL): Cardiovascular system assessment; RA patients have 1.5-2 times higher cardiovascular mortality risk. Monitor lipid parameters for atherosclerotic disease prevention
    • Total Protein, Albumin, Globulin, A/G Ratio: Hepatic synthesis and nutritional status assessment; evaluate for chronic disease effects on protein metabolism and malnutrition in severe arthritis
    • Thyroid Profile (T3, T4, TSH): Endocrine system assessment; autoimmune thyroid disease frequently coexists with RA. Thyroid dysfunction affects disease activity and treatment response
    • C-Reactive Protein (CRP): Systemic inflammation marker; indicates active inflammation throughout the body, correlates with joint damage progression and extra-articular manifestations in arthritis
    • HbA1c and eAG: Endocrine (pancreatic) system assessment; evaluate for diabetes development in arthritis patients where chronic inflammation increases metabolic syndrome risk
    • CBC (Complete Hemogram): Hematopoietic system assessment; anemia of chronic disease is common in RA. Leukopenia and thrombocytopenia may result from disease or DMARD toxicity requiring monitoring
  • Follow-up Tests
    • Abnormal Calcium/Alkaline Phosphatase: Order bone mineral density testing (DEXA scan), vitamin D 25-OH level, parathyroid hormone (PTH), X-rays of affected joints to assess for osteoporosis and erosive changes
    • Elevated SGOT/SGPT/GGT/Bilirubin: Obtain hepatitis B surface antigen, hepatitis C antibody, abdominal ultrasound or CT, consider liver biopsy if marked elevation or clinical suspicion of cirrhosis. Repeat LFTs in 1-2 weeks
    • Elevated Uric Acid: Measure 24-hour urine uric acid, obtain serum urate-lowering therapy if recurrent gout, order joint imaging to assess for tophi and bone erosions
    • Low Complement 3/Positive ASO: Order Complement 4 (C4), erythrocyte sedimentation rate (ESR), additional autoimmune markers (anti-dsDNA, anti-Sm for SLE evaluation), throat culture if ASO elevated
    • Abnormal Renal Function (BUN/Creatinine): Obtain 24-hour urine creatinine for GFR calculation, serum cystatin C, urine microscopy and proteinuria assessment, renal ultrasound if acute deterioration, nephrology referral if severe
    • Positive RF/ANA/Anti-CCP: Order specific ANA reflex panel (anti-dsDNA, anti-Sm, anti-Ro, anti-La, anti-centromere), additional autoantibodies (anti-histone, anti-MDA-5), Complement levels, tissue typing (HLA-B27) for spondyloarthropathies
    • Abnormal Iron Studies: Obtain peripheral blood smear, iron saturation percentage, ferritin level, reticulocyte count, stool test for occult blood if iron deficiency suspected
    • Abnormal Lipid Profile: Order lipoprotein(a), apolipoprotein B, advanced lipid testing, assess cardiovascular risk with carotid intima-media thickness ultrasound or coronary calcium scoring if indicated
    • Abnormal Protein/Albumin: Obtain comprehensive metabolic panel, serum protein electrophoresis if suspecting paraproteinemia, assess nutritional status with dietary consultation, evaluate for malabsorption
    • Abnormal Thyroid Function: Order free T3, free T4, TSH receptor antibody, anti-thyroid peroxidase antibody, anti-thyroglobulin antibody, thyroid ultrasound if nodules suspected
    • Elevated CRP: Obtain erythrocyte sedimentation rate (ESR), high-sensitivity CRP (hs-CRP) for serial monitoring, assess for infection or malignancy if disproportionately elevated
    • Elevated HbA1c/eAG: Order fasting glucose, random glucose, oral glucose tolerance test, hemoglobin F if hemolytic disease present affecting HbA1c interpretation, endocrinology referral if diabetic
    • Abnormal CBC: Obtain peripheral blood smear, reticulocyte count, LDH and haptoglobin for hemolysis assessment, B12 and folate if macrocytic features present, consider bone marrow biopsy if pancytopenia
    • Monitoring During Treatment: Repeat Advanced Arthritis Profile every 3-6 months during DMARD therapy, every 6-12 months if stable on biologics, annually at minimum for long-term disease monitoring
    • Clinical Correlation: Order imaging studies (plain films, ultrasound, MRI) based on clinical presentation and laboratory findings, rheumatology consultation for complex cases or diagnostic uncertainty
  • Fasting Required?
    • Yes - Fasting Required: 8-12 hours overnight fast is recommended for accurate lipid profile measurement (cholesterol, HDL, LDL, triglycerides, VLDL) and blood glucose-related tests (HbA1c, eAG)
    • Fasting Duration: Ideally 8-12 hours of fasting before blood draw; minimum acceptable is 8 hours. Overnight fasting from 10 PM with morning blood draw is standard practice
    • Medications to Avoid: Do not discontinue regular medications without physician guidance; NSAIDs and DMARDs should be continued as prescribed. Avoid starting new medications the day before testing without discussion with provider
    • Dietary Restrictions: NPO (nothing by mouth) except water from midnight before blood draw. Avoid alcohol for 24 hours before testing as it affects lipid and liver enzyme measurements
    • Fluid Intake: Water is acceptable and encouraged during the fasting period. Adequate hydration improves blood draw quality and reduces hemolysis of samples
    • Timing Considerations: Schedule appointment in early morning (6-10 AM) when possible, as diurnal variation affects cortisol and some inflammatory markers. Early appointments maximize adherence to fasting requirements
    • Activity Restrictions: Avoid strenuous exercise for 24 hours before testing, as physical exertion increases inflammatory markers (CRP, ESR) and muscle enzymes (AST, ALT)
    • Stress Reduction: Minimize emotional stress before testing, as stress hormones affect glucose, lipids, and inflammatory markers. Allow 10-15 minutes of rest before phlebotomy if possible
    • Disease State Considerations: During acute arthritis flares, inflammatory markers may be falsely elevated. Timing blood draws during stable disease periods when possible provides more representative baseline values
    • Specific Test Considerations: RF, ANA, Anti-CCP, Complement 3, CRP, and CBC do NOT require fasting. Lipid panel, glucose (HbA1c, eAG), and liver function tests require fasting for optimal accuracy

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