Professional and Linguistic Assessments Board (PLAB) Practice Exam

Which type of arthritis requires the identification of anti-citrullinated protein antibodies (ACPA) for a definitive diagnosis?

1. Osteoarthritis

2. Rheumatoid arthritis

3. Psoriatic arthritis

4. Gout

The correct answer is: Rheumatoid arthritis

The identification of anti-citrullinated protein antibodies (ACPA) is specifically associated with rheumatoid arthritis, making it crucial for a definitive diagnosis of this condition. ACPA are autoantibodies that target proteins that have undergone citrullination, a post-translational modification that is thought to play a role in the pathogenesis of rheumatoid arthritis. The presence of these antibodies, alongside other clinical findings and lab tests, can support the diagnosis and help differentiate rheumatoid arthritis from other types of arthritis. In contrast, osteoarthritis, psoriatic arthritis, and gout do not rely on the presence of ACPA for diagnosis. Osteoarthritis, for example, is primarily diagnosed based on clinical symptoms and imaging studies showing joint degeneration. Psoriatic arthritis may involve other specific markers, such as HLA-B27, but not ACPA. Gout is diagnosed through the identification of monosodium urate crystals in joint fluid or tophi, rather than serological markers like ACPA. Thus, the presence of ACPA is a defining characteristic for the diagnosis of rheumatoid arthritis specifically.