Rheumatoid Arthritis Factor Test

main product photo
SKU
Rheumatoid Arthritis Factor Test
Special Price $25.00 Regular Price $54.94

First time customer? Read How Discounted Labs Works 

IMPORTANT NOTICE ABOUT DISCOUNTED LABS SERVICES: We currently serve the following states:

Alabama, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, North Carolina, New Mexico, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Virginia and Washington.

Other states will be added in the coming months, so please subscribe to our newsletter on the website footer to be notified.

The Rheumatoid Arthritis Factor is often evaluated in patients suspected of having any form of arthritis or destructive articular disease even though positive results can be due to other causes, and negative results do not rule out disease. But, in combination with signs and symptoms, it can play a role in both diagnosis and disease prognosis. It is part of the usual disease criteria of rheumatoid arthritis.

Understanding Rheumatoid Arthritis Blood Tests

Key Highlights

  • Rheumatoid arthritis (RA) blood tests play a crucial role in diagnosing and monitoring the disease
  • Key markers of inflammation, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), are measured in blood tests to assess disease activity
  • Common blood tests for RA include rheumatoid factor (RF) test and anti-CCP antibody test
  • Advanced blood tests like ANA test and comprehensive metabolic panel (CMP) are used for monitoring RA and overall health
  • Interpreting blood test results helps in understanding disease progression and making treatment decisions
  • The future of blood testing for RA holds promise with emerging biomarkers and personalized medicine options

Introduction

Diagnosing rheumatoid arthritis (RA) can be challenging and time-consuming. It requires a combination of medical examinations, symptom evaluations, and blood tests. Blood tests, such as the rheumatoid arthritis diagnosis test, are an essential tool in the diagnosis and monitoring of RA. They help healthcare professionals assess disease activity, identify key markers of inflammation, and make informed treatment decisions. During the physical exam, your doctor will also check for signs of RA, such as joint swelling, redness, and warmth. Understanding the role of blood tests, imaging tests, and physical exams in diagnosing and managing RA is crucial for both patients and healthcare providers.

In this blog, we will explore the significance of blood tests in diagnosing and monitoring rheumatoid arthritis. We will discuss the immune system's impact on RA, the key markers of inflammation measured in blood tests, common blood tests used for RA, advanced blood tests for monitoring the disease, interpreting blood test results, and the treatment options based on these results. Additionally, we will delve into the future of blood testing for RA, which includes emerging biomarkers and the potential for personalized medicine.

By gaining a comprehensive understanding of rheumatoid arthritis blood tests, patients and healthcare providers can work together to effectively manage the disease, monitor disease activity, and make informed treatment decisions.

The Role of Blood Tests in Diagnosing Rheumatoid Arthritis

Blood tests play a crucial role in the diagnosis of rheumatoid arthritis (RA). While a medical examination and evaluation of symptoms are important, blood tests provide objective data that can confirm the presence of RA and help rule out other conditions.

The immune system has a significant impact on the development and progression of RA. In RA, the immune system mistakenly attacks healthy tissues, leading to chronic inflammation and joint damage. Blood tests can assess the activity of the immune system by measuring key markers of inflammation.

Two main markers of inflammation measured in blood tests are erythrocyte sedimentation rate (ESR, or sed rate) and C-reactive protein (CRP). ESR measures how quickly red blood cells settle in a test tube, indicating the presence of inflammation in the body. In response to inflammation, the liver produces CRP. Elevated levels of ESR and CRP, also known as sed rate and CRP, as well as sgot levels, are common in RA and indicate higher disease activity in healthy people.

In addition to markers of inflammation, specific antibodies can also be measured in blood tests to aid in the diagnosis of RA. The immune system can attack healthy tissues with rheumatoid factor (RF), an antibody. High levels of RF may indicate a diagnosis of RA, although it can also be present in other autoimmune diseases. This antibody test, called the anti-CCP antibody test, looks for cyclic citrullinated peptide (CCP) antibodies, which are present in the blood of many people with RA. These antibodies are particularly important in diagnosing severe rheumatoid arthritis, as those who test positive for both RF and anti-CCP may be more likely to have a more severe form of the disease that requires higher levels of treatment from their health care team.

Understanding the Immune System's Impact

The immune system plays a crucial role in the development and progression of rheumatoid arthritis (RA). In RA, the immune system mistakenly attacks healthy tissues, leading to chronic inflammation and joint damage.

The immune response in RA begins with the activation of immune cells, particularly B cells and T cells. B cells produce antibodies, including rheumatoid factor (RF) and anti-CCP antibodies, which can attack healthy tissues. T cells, on the other hand, regulate the immune response and contribute to the production of inflammatory cytokines.

In RA, the immune system's response results in chronic inflammation, which destroys joint tissues like cartilage and bone. This inflammation can also affect other organs and systems in the body, leading to a wide range of symptoms and complications.

Understanding the impact of the immune system in RA is crucial for developing targeted treatments that can modulate the immune response and reduce inflammation. By targeting specific immune cells and inflammatory pathways, healthcare providers can effectively manage RA and improve patient outcomes.

Key Markers of Inflammation and Their Significance

Markers of inflammation measured in blood tests provide valuable insights into the disease activity and severity of rheumatoid arthritis (RA). Some key markers of inflammation include:

  • Erythrocyte Sedimentation Rate (ESR): Measures how quickly red blood cells settle in a test tube, indicating the presence of inflammation in the body.
  • C-Reactive Protein (CRP): A protein produced by the liver in response to inflammation. Elevated levels of CRP indicate increased disease activity.
  • Rheumatoid Factor (RF): An antibody produced by the immune system that can attack healthy tissues. High levels of RF may indicate a diagnosis of RA.
  • Anti-CCP Antibodies: Antibodies that target cyclic citrullinated peptides, which are found in the blood of many people with RA.This test is not available on DiscountedLabs.com

These markers help healthcare providers assess disease activity, monitor treatment response, and make informed decisions regarding medication adjustments and disease management.

It's important to note that while these markers are indicative of inflammation, they are not specific to RA and can be elevated in other conditions as well. Therefore, they are typically used in combination with other clinical and imaging findings to make a definitive diagnosis and guide treatment.

Common Blood Tests for Rheumatoid Arthritis

In addition to the key markers of inflammation discussed earlier, several other blood tests are commonly used in the diagnosis and monitoring of rheumatoid arthritis (RA). These tests include:

  • Complete Blood Count (CBC): Measures the number and quality of red and white blood cells, providing insights into anemia and potential complications from RA or its treatment.
  • Liver Enzyme Tests: Evaluate liver function and detect any liver damage that may be related to RA treatment or an associated autoimmune condition.
  • Kidney Function Tests: Assess the kidneys' ability to remove waste products from the body, as kidney damage can occur due to RA itself or medications used to treat it.
  • Lipid Panel: Measures triglyceride and cholesterol levels, as certain RA medications may cause increases in lipid levels.

These common blood tests provide valuable information about overall health and help healthcare providers monitor various aspects of RA, including potential side effects of medications and disease-related complications.

Rheumatoid Factor (RF) Test Explained

The rheumatoid factor (RF) test is a common blood test used in the diagnosis and monitoring of rheumatoid arthritis (RA). The immune system can attack healthy tissues with RF, an antibody it produces. A positive rheumatoid factor test result shows that you have a higher level of rheumatoid factor in your blood, which is closely linked with autoimmune diseases, especially rheumatoid arthritis. However, it is important to note that RF levels may also be high in other autoimmune diseases, such as Sjogren’s syndrome, and therefore, a rheumatoid factor test is crucial in diagnosing and monitoring various autoimmune conditions.

The RF test involves taking a blood sample and measuring the levels of RF antibodies present. It is often used in combination with other clinical and imaging findings to make a definitive diagnosis of RA.

However, it's important to note that a positive RF test result alone does not confirm a diagnosis of RA. RF levels can be elevated in other conditions and even in some healthy individuals. Therefore, healthcare providers consider RF test results, which are obtained by taking a blood sample from a vein, in the context of other clinical findings and symptoms before making a diagnosis.

The RF test is also useful in monitoring disease activity and treatment response in individuals already diagnosed with RA. Changes in RF levels over time can provide insights into the effectiveness of medication and disease progression.

Anti-CCP Antibody Test: What You Need to Know

The anti-CCP antibody test is another blood test used in the diagnosis and monitoring of rheumatoid arthritis (RA). It checks for the presence of antibodies called cyclic citrullinated peptide (CCP) antibodies in the blood. These antibodies are found in the blood of a significant percentage of people with RA.

Similar to the rheumatoid factor (RF) test, the anti-CCP antibody test helps healthcare providers confirm a diagnosis of RA when used in combination with other clinical and imaging findings. High levels of anti-CCP antibodies indicate a higher likelihood of having RA.

The anti-CCP antibody test is particularly useful in diagnosing RA in its early stages. It can detect the presence of antibodies before symptoms appear and joint damage occurs.

In addition to its diagnostic value, the anti-CCP antibody test also helps healthcare providers monitor disease activity and treatment response in individuals with RA. Changes in anti-CCP antibody levels over time can provide insights into disease progression and guide treatment decisions.

The ESR Test: Measuring Inflammation Levels

The erythrocyte sedimentation rate (ESR) test is a blood test used to measure the levels of inflammation in the body. It provides insights into the activity of rheumatoid arthritis (RA) and other inflammatory conditions.

During the ESR test, a blood sample is taken and placed in a test tube. The rate at which red blood cells settle to the bottom of the tube is measured. Faster settling indicates higher levels of inflammation in the body.

Elevated ESR levels are common in individuals with RA due to the chronic inflammation associated with the disease. However, it's important to note that an elevated ESR alone is not specific to RA and can be seen in other conditions as well.

The ESR test is often used in combination with other clinical findings and blood tests to assess disease activity and monitor the effectiveness of treatment in individuals with RA. Changes in ESR levels over time can provide valuable information about disease progression and response to therapy.

CRP Test: Another Indicator of Inflammation

The C-reactive protein (CRP) test is a blood test used to measure the levels of C-reactive protein in the body. In response to inflammation, the liver produces CRP.

Elevated CRP levels are indicative of inflammation and are commonly seen in rheumatoid arthritis (RA) and other inflammatory conditions. The CRP test provides valuable insights into disease activity and can help healthcare providers monitor the effectiveness of treatment.

The CRP test involves taking a blood sample and measuring the levels of CRP present. The results are usually reported as milligrams per liter (mg/L) of blood.

It's important to note that elevated CRP levels alone are not specific to RA and can be seen in other conditions as well. Therefore, the CRP test is often used in combination with other clinical findings and blood tests to assess disease activity and guide treatment decisions in individuals with RA. The results of other tests must be interpreted in the context of your symptoms to determine the presence and severity of inflammation.

Advanced Blood Tests for Monitoring Rheumatoid Arthritis

In addition to the common blood tests used for diagnosing and monitoring rheumatoid arthritis (RA), there are advanced blood tests that provide more detailed insights into the disease and overall health. These tests include:

  • Antinuclear Antibody (ANA) Test: Detects the presence of antibodies that attack the body's own cells, indicating autoimmune conditions such as RA and lupus.
  • Comprehensive Metabolic Panel (CMP): assesses kidney function, liver damage, and overall health by measuring various markers in the blood.
  • MBDA Test (Vectra DA): Measures 12 proteins, hormones, and growth factors to provide a disease activity score and help guide treatment decisions.

These advanced blood tests complement the common tests and provide a more comprehensive picture of disease activity and overall health in individuals with RA. They help healthcare providers monitor treatment responses, detect any potential complications, and make informed decisions regarding medication adjustments and disease management.

ANA Test: Detecting Autoimmune Diseases

The antinuclear antibody (ANA) test is a blood test used to detect the presence of antibodies that attack the body's own cells. These antibodies, known as antinuclear antibodies, are indicative of autoimmune conditions, including rheumatoid arthritis (RA) and lupus.

During the ANA test, a blood sample is taken and tested for the presence of these antibodies. Positive ANA test results suggest the presence of an autoimmune disease, but further evaluations are needed to confirm the specific condition.

While the ANA test is not specific to RA, it is a useful tool in diagnosing autoimmune diseases and assessing disease activity. It is often used in combination with other clinical findings and blood tests to make a definitive diagnosis and guide treatment decisions.

The ANA test is particularly helpful in identifying individuals who may be at risk for developing RA or other autoimmune conditions, even before symptoms appear. Early detection allows for early intervention and management of the disease.

Comprehensive Metabolic Panel (CMP): Monitoring Overall Health

The comprehensive metabolic panel (CMP) is a blood test that provides valuable information about various aspects of overall health. It measures different markers in the blood, including liver function, kidney function, electrolyte levels, and blood glucose.

A CMP typically includes the following measurements:

Marker

Normal Range

Kidney Function

Creatinine, BUN

Liver Function

ALT, AST, Bilirubin, ALP

Electrolytes

Sodium, Potassium, Chloride

Blood Glucose

Fasting Blood Glucose

Protein Levels

Total Protein, Albumin, Globulin

Calcium Levels

Total Calcium, Ionized Calcium

The results of a CMP help healthcare providers evaluate overall health, assess kidney and liver function, detect any abnormalities, and monitor the potential side effects of medications used to treat rheumatoid arthritis (RA). It provides important insights into the overall well-being of individuals with RA and helps guide treatment decisions.

Interpreting Blood Test Results for Rheumatoid Arthritis

Interpreting blood test results is crucial for understanding disease progression, monitoring treatment response, and making informed decisions regarding rheumatoid arthritis (RA) management. The results of blood tests, along with clinical findings and symptoms, provide valuable information about disease activity and severity.

What Normal and Abnormal Results Mean

Blood test results for rheumatoid arthritis (RA) can be classified as either normal or abnormal, indicating different levels of disease activity and severity. It's important to understand what these results mean in order to effectively manage and monitor RA.

Normal results indicate that the levels of specific markers in the blood fall within a healthy range. However, normal results do not necessarily mean that RA is not present. Many individuals with RA have normal blood test results, especially in the early stages of the disease.

Abnormal results, on the other hand, indicate that the levels of specific markers in the blood are outside the normal range. More rheumatoid factor (RF), anti-CCP antibodies, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) in the blood means the disease is worse and more active.

It's important to note that abnormal blood test results alone do not provide a definitive diagnosis of RA. They are typically used in combination with clinical findings and symptoms to make an accurate diagnosis and guide treatment decisions.

The Importance of Regular Monitoring and Follow-Up

Regular monitoring and follow-up are essential components of rheumatoid arthritis (RA) management. Blood tests play a crucial role in monitoring disease activity, assessing treatment response, and making informed decisions regarding medication adjustments.

By regularly monitoring blood test results, healthcare providers can track changes in disease activity over time. High levels of rheumatoid factor (RF), anti-CCP antibodies, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) may show that the disease is getting worse and that the treatment needs to be changed.

Regular follow-up visits with healthcare providers allow for comprehensive evaluations of disease progression, joint damage, and overall health. These visits provide an opportunity to discuss treatment options, address any concerns or questions, and ensure that the treatment plan is aligned with the patient's goals and needs.

Taking an active role in regular monitoring and follow-up can help individuals with RA effectively manage the disease, optimize treatment outcomes, and improve their overall quality of life.

Treatment Options Based on Blood Test Results

Blood test results for rheumatoid arthritis (RA) play a crucial role in guiding treatment decisions. These results provide valuable insights into disease activity, severity, and treatment response, allowing healthcare providers to individualize treatment plans for each patient.

Based on blood test results, healthcare providers may recommend the following treatment options:

  • Medication Changes: High levels of rheumatoid factor (RF), anti-CCP antibodies, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) may show that the disease is getting worse and that medication changes are needed. Healthcare providers may increase or change the dosage of medications to achieve better disease control.
  • Treatment Plan Modifications: Blood test results provide important information about disease progression and treatment response. Healthcare providers may modify the treatment plan by adding or switching medications to improve outcomes and minimize side effects.
  • Pain Relief Strategies: Blood test results, along with clinical findings, can help healthcare providers identify the underlying causes of pain in RA. They can then recommend appropriate pain relief strategies, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids, to alleviate pain and improve quality of life.

It is important for individuals with RA to work closely with their healthcare providers, regularly monitor blood test results, and discuss treatment options to ensure optimal disease management and symptom control.

Medication Adjustments and Recommendations

Medication adjustments are common in the management of rheumatoid arthritis (RA) and are often based on blood test results. High levels of rheumatoid factor (RF), anti-CCP antibodies, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) may show that the disease is getting worse and that the patient needs to change their medications.

Healthcare providers may recommend the following medication adjustments:

  • Increasing Dosage: If blood test results indicate increased disease activity, healthcare providers may increase the dosage of disease-modifying antirheumatic drugs (DMARDs) or biologic response modifiers to achieve better disease control.
  • Switching Medications: If a particular medication is not effectively managing the disease or if side effects are intolerable, healthcare providers may recommend switching to a different medication.
  • Combination Therapy: In some cases, healthcare providers may prescribe multiple medications in combination to achieve optimal disease control. This approach may require regular monitoring of blood test results to ensure the effectiveness and safety of the combination therapy.

It's important for individuals with RA to work closely with their healthcare providers, communicate any changes in symptoms or side effects, and follow the recommended medication adjustments to achieve better disease management and improve quality of life.

The Role of Diet and Lifestyle in Managing RA

While blood tests play a crucial role in the management of rheumatoid arthritis (RA), lifestyle factors, including diet, exercise, and overall health, also contribute to disease management. While there is no specific diet that can cure RA, certain dietary choices and lifestyle modifications can help alleviate symptoms such as pain, stiffness, inflammation, and swelling, and improve overall well-being.

A healthy, balanced diet rich in fruits, vegetables, whole grains, and lean proteins can provide essential nutrients and support overall health. Omega-3 fatty acids found in fatty fish, flaxseeds, and walnuts have anti-inflammatory properties and may help reduce joint pain and inflammation in RA.

Regular physical activity, such as low-impact exercises, can help improve joint flexibility, maintain muscle strength, and reduce pain. It's important to work with a healthcare provider or physical therapist to develop an exercise plan that is tailored to individual needs and abilities.

Additionally, managing stress levels, getting adequate sleep, and avoiding smoking can also contribute to better disease management and overall health in individuals with RA.

The Future of Blood Testing for Rheumatoid Arthritis

The future of blood testing for rheumatoid arthritis (RA) holds promise with advancements in emerging biomarkers and personalized medicine. These innovations have the potential to improve diagnosis, treatment decisions, and patient outcomes.

Emerging biomarkers, such as genetic markers and specific protein profiles, are being studied for their potential to enhance the accuracy and specificity of RA diagnosis. These biomarkers may provide insights into disease progression, treatment response, and personalized treatment options.

Genetic testing is another area of advancement in blood testing for RA. By examining specific genetic variations associated with RA, healthcare providers may be able to identify individuals at higher risk for developing the disease and tailor treatment plans accordingly.

Personalized medicine approaches are also being explored, aiming to provide individualized treatment based on a patient's unique characteristics, including genetic makeup, disease activity, and treatment response. With personalized medicine, healthcare providers can optimize treatment outcomes and minimize potential side effects.

While these advancements are still in the research phase, they hold great potential for improving the diagnosis, treatment, and management of RA. Continued research and development in the field of blood testing for RA are essential for advancing personalized and targeted approaches to disease management.

Emerging Biomarkers and Genetic Testing

Emerging biomarkers and genetic testing are at the forefront of research in blood testing for rheumatoid arthritis (RA). These advancements have the potential to enhance the accuracy of RA diagnosis, provide insights into disease progression, and guide personalized treatment decisions.

Emerging biomarkers, such as specific protein profiles and genetic markers, are being studied for their ability to detect RA at an early stage, predict disease severity, and identify treatment responses. These biomarkers may offer a more targeted approach to disease management, allowing for personalized treatment plans.

Genetic testing is another area of research in blood testing for RA. By examining specific genetic variations associated with RA, healthcare providers may be able to identify individuals at higher risk for developing the disease and tailor preventive measures and treatment plans accordingly.

While these advancements are still in the early stages of research, they hold great promise for improving the accuracy of RA diagnosis, optimizing treatment outcomes, and advancing personalized medicine approaches in the future.

Personalized Medicine and RA Management

Personalized medicine approaches are being explored in the context of rheumatoid arthritis (RA) management. Personalized medicine aims to provide individualized treatment based on a patient's unique characteristics, including genetic makeup, disease activity, and treatment response.

In the field of RA, personalized medicine holds the potential to optimize treatment outcomes, minimize potential side effects, and tailor treatment plans according to each patient's specific needs. By analyzing genetic variations associated with RA, healthcare providers may be able to identify individuals who are more likely to respond to certain medications or have a higher risk of developing certain complications.

Furthermore, personalized medicine approaches can help guide treatment decisions by considering disease activity measured through blood tests, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels.

While personalized medicine in RA is still an evolving field, ongoing research and advancements in blood testing technology are paving the way for more targeted and effective treatment options. Personalized medicine holds great promise for improving RA management and enhancing patient outcomes.

Conclusion

Blood tests play a crucial role in diagnosing and monitoring Rheumatoid Arthritis. By understanding the immune system's impact and key markers of inflammation, healthcare providers can interpret results accurately to tailor treatment plans. Regular monitoring through advanced blood tests like ANA and CMP aids in personalized medicine for effective RA management. It's essential to comprehend normal versus abnormal results, emphasizing the significance of follow-up appointments. With emerging biomarkers and genetic testing, the future of blood testing holds promise for improved diagnostic accuracy and treatment outcomes. Stay informed and proactive in managing your RA with comprehensive blood testing.

Frequently Asked Questions

What is the most reliable rheumatoid arthritis blood test?

The most reliable blood test for diagnosing rheumatoid arthritis (RA) is a combination of multiple tests, including rheumatoid factor (RF), anti-CCP antibody, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). These tests, along with clinical findings and symptoms, provide a comprehensive evaluation for an accurate diagnosis.

How often should blood tests be conducted for monitoring RA?

The frequency of blood tests for monitoring rheumatoid arthritis (RA) varies depending on the individual's disease activity and treatment plan. In general, blood tests are conducted regularly to assess disease activity, treatment response, and potential side effects. Healthcare providers will determine the appropriate frequency of blood tests based on the individual's specific needs.

How accurate is a blood test for diagnosing rheumatoid arthritis?

Blood tests, such as rheumatoid factor (RF) and anti-CCP antibody tests, are important tools in diagnosing rheumatoid arthritis (RA). While these tests can provide valuable insights into the disease, they are not definitive on their own. They are typically used in combination with other clinical findings and symptoms to make an accurate diagnosis.

Is it possible to have false positive or false negative results with a rheumatoid arthritis blood test?

Yes, it is possible to have false positive or false negative results with a rheumatoid arthritis (RA) blood test. Rheumatoid factor (RF) and anti-CCP antibody tests can yield false positive results in individuals without RA, while false negative results can occur in individuals with RA. Therefore, these tests are typically used in combination with other clinical findings and symptoms for an accurate diagnosis.

 

References:

C-Reactive Protein (CRP) Test

Rheumatoid Factor (RF) Test

Ana testing

Understanding Rheumatoid Arthritis Blood Tests - Arthritis.org

HOW DOES DISCOUNTEDLABS.COM WORK?

  1. Go to the "Find a Location" page to find the closest lab location. No need to make an appointment since walk-ins are welcomed. Once you have identified your closest location, go to step 2.

  2. Go to "Choose a Test" and add your selection (s) in the shopping cart. If you prefer to save money on bundled tests, we have created "Lab Test Panels" that can help you decide what to order.

  3. If you have a discount coupon code, add it to your cart.

  4. A $8 lab processing fee will be added to your total.

  5. Pay using a credit card.

  6. You will receive an order confirmation and instructions email on how to download your lab request.

  7. Print lab request form that you downloaded.

  8. Take that form to the closest location. Get your blood drawn.

  9. You will receive an email when the results are ready for you to download.

    Note: You cannot place an order under someone else's profile. The profile person's name will appear on the lab order form.

     

    If you have further questions, please email [email protected].