BLOOD SUGAR LEVEL – Fasting (BSL-F)

A 10-12 hour fasting sample is advisable.

Diagnostic for diabetes. Certain drugs like steroids can raise blood sugar level. Often a oral glucose tolerance test is required to confirm diabetes in asymptomatic patient with raised BSL

BLOOD SUGAR LEVEL – Random (BSL-R)

Used to screen BSL in a non fasting state or any time not necessarily 2 hours post prandial

Abnormal values need to be checked with fasting and post prandial testing

BLOOD SUGAR LEVEL – Post prandial (BSL-PP)

A post-prandial sample 2 hours after lunch is best preferred.

Both BSL (F) and BSL (PP) are commonly done for diagnosis and monitoring of diabetics.

KIDNEY FUNCTION TESTS (KFT)

Blood urea nitrogen and serum creatinine level; fasting state not required.

To assess kidney function; should be done for evaluation of systemic rheumatic diseases and prior to beginning long term drugs; must be done to monitor drugs with potential kidney side effects. Kidneys may be affected in certain rheumatic diseases (SLE, Gout) and by long term use of pain killers and other drugs.

SERUM URIC ACID

Fasting state not required; normal range varies form lab to lab; different normal values for men and pre-menopausal women.

For diagnosis of gout but asymptomatic raised values need clinical correlation. The diagnosis of gout is essentially clinical and should be based on a classical clinical profile. Kidney functions must be also checked as uric acid is excreted by the kidneys. Patients with prolonged raised levels of serum uric acid or gout must also be screened for elevated lipids and cardiovascular diseases. Pre-menopausal women rarely if ever suffer from gout.. Certain drugs e.g. Diuretics, beta-blockers, can also cause elevated serum uric acid levels.

SERUM CALCIUM

Fasting state not required; total calcium is usually measured though it is the free fraction which is more important. Several factors influence blood levels.

Blood levels do not per se indicate calcium deficiency. Other test (e.g. XRays, fraction measures, etc) are more important. Calcium levels are of importance in parathyroid disorders, multiple myeloma, metabolic bone disorder.

SERUM PHOSPHOROUS

Fasting state not required; Routinely interpreted with calcium levels.

LIVER FUNCTION TESTS (LFT)

Fasting state not required. includes serum proteins (albumen & globulin), serum bilirubin, and serum enzymes- gamma GT, SGPT, SGOT and Alkaline phosphatase.

The need to do for entire LFT or one of its components may depend upon the indication in any particular patient. Usually, full LFT is done as part of a health check up or before beginning long term therapy. Later, serum enzymes esp gamma GT or SGPT is used to monitor drug effects in long term therapy (e.g. methotrexate, Leflunomide, etc). Certain rheumatic diseases e.g. SLE may affect liver. But LFT is more important to monitor drug effects. Low serum albumin may indicate poor nutrition. Altered liver enzymes and, increased bilirubin is seen in various viral hepatitis, alcoholic hepatitis etc. Serum bilirubin is a marker for jaundice.

LIPID PROFILE

At least 14 hours fasting is desirable. Includes serum cholesterol, triglycerides, High Density cholesterol (HDL), Low Density cholesterol (LDL) and Very Low Density Level Cholesterol (VLDL).

Hyperlipidemia is a common co-existing condition in many patients with RA, SLE, gout and being a coronary risk factor, should be identified at the earliest. Some anti-rheumatic drugs e.g. Steroids can also alter serum lipids levels.

CREATININE PHOSPHOKINASE (CPK)

Fasting state not required; It is the most sensitive enzyme for muscle diseases.

Elevated in various disorders with muscle necrosis or injury. Such conditions include polymyositis, rhabdomyolysis, trauma, and some neuromuscular dystrophies.