Proteins whose levels increase in inflammation are called positive acute phase reactants, and proteins whose levels decrease in inflammation are called negative acute phase reactants.
Positive acute phase reactants
Serum amyloid A
Fibrinogen (Erythrocyte sedimentation rate)
C- Reactive protein
ferritin
Alpha-1 antitrypsin
haptoglobin
Ceruloplasmin
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Ngative acute phase reactants
prealbumin
Albumin
Retinol binding globulin
transferrin
Proinflammatory cytokines such as IL-1 and TNF alpha, especially IL-6, are responsible for the acute phase response.
Acute phase reactants are not diagnostic for any disease because they change as a result of non-specific inflammatory stimuli. However, they can be used to evaluate the presence or severity of an inflammatory condition and to follow disease activity after diagnosis.
• While evaluating joint complaints, the following questions should be answered;
o Is it inflammatory or non-inflammatory?
• The following features can be found in inflammatory diseases;
Cardinal signs of inflammation (erythema, increased temperature, pain, swelling)
Laboratory findings of inflammation (acute phase reactant increase, anemia, ...)
Systemic symptoms (fatigue, fever, rash, weight loss, ...)
Joint stiffness that is prolonged (> 30 min) and decreases with activity
o Retention period?
• < 6 weeks: Acute
• > 6 weeks: Chronic
o Number of joints involved?
• 1 joint: Monoarticular
• 2-4 joints: Oligoartricular
• 2: 5 joints: Polyarticular
Acute monoarthritis: Septic arthritis, Crystal arthritis (gout, pseudogout)
Asymmetric oligoarthritis: Spondyloarthropathies
Migratory arthritis: Acute rheumatic fever, Gonococcal arthritis
Symmetrical polyarthritis: Rheumatoid arthritis, SLE
Joint Fluid Analysis
• Classification of arthritis according to synovial fluid analysis
o Non-inflammatory arthritis: Osteoarthritis
o Inflammatory arthritis: Rheumatoid arthritis, Crystal arthritis (gout, pseudogout), Seronegative spondyloarthritis
o Septic arthritis
