By Patience H. White MD, MA, Rowland W. Chang MD, MPH (auth.), John H. Klippel MD, John H. Stone MD, MPH, Leslie J. Crofford MD, Patience H. White MD, MA (eds.)
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Additional resources for Primer on the Rheumatic Diseases
Antinuclear antibodies (ANA) are found in many patients with rheumatic diseases and in essentially all patients with systemic lupus erythematosus (SLE) and systemic sclerosis. Under the proper clinical conditions, the finding of a positive ANA assay is an indication for additional investigations directed at identifying the precise autoantibody leading to the ANA pattern. Among others, anti-Ro, -La, -Sm, and -RNP antibodies may all result in a positive ANA. These autoantibodies are associated with a range of different rheumatic diseases.
When red blood cells (RBCs) interact with these proteins, they form clusters that sediment at a faster rate than individual RBCs. In chronic states of inflammation, decreased serum albumin and hematocrit levels also lead to increased rates of erythrocyte sedimentation. Method (Westergren) Whole serum is anticoagulated with sodium citrate and allowed to stand. After 1 hour, the distance in millimeters between the top of the tube and the erythrocyte sediment is measured. The test is sensitive to handling and temperature (1).
The normal curvature of the spine, lumbar lordosis, thoracic kyphosis, and cervical lordosis should be evaluated by observing the patient from the both the back and the side, and any loss or accentuation of these curves noted. If scoliosis is noted with the patient standing upright, they should be asked to bend forward and flex the spine to evaluate the effects of this movement on the scoliosis. True scoliosis will be present irrespective of the state of spinal flexion, while a functional scoliosis due to leg length discrepancy will tend to decrease with spinal flexion.