What does a vial of blood or joint fluid reveal to your doctor

by Dr Anuradha Venugopalan

More than for most other diseases, the diagnosis and treatment of arthritis require a hands-on approach. By examining your tender joints and muscles and listening to your description of your symptoms and their severity, a doctor can usually get a pretty good idea of what’s going on inside your body. But there are many times when a doctor needs information that only a laboratory examination of bodily fluids and tissues can reveal. When he needs to confirm a diagnosis, monitor disease progress or medication effectiveness, or determine if the drugs you’re taking are causing potentially dangerous – but not evident – side effects, lab tests are in order.
The majority of lab tests are performed on blood because it is easily and safely sampled and it holds many microscopic clues to what’s going on throughout the body. Other tests may require urine, joint fluid or even small pieces of skin or muscle.
The following blood tests are commonly performed to detect or evaluate rheumatologic disorders, including systemic lupus erythematosus (SLE), scleroderma, blood vessel inflammation (vasculitis) and types of arthritis (osteoarthritis, rheumatoid arthritis, psoriatic arthritis, gout and ankylosing spondylitis).
Rheumatoid factor (RF)–  This test is designed to detect and measure the level of an antibody that acts against the blood component gamma globulin, this test is often positive in people with rheumatoid arthritis (RA). About 80% of patients with RA test positive for rheumatoid factor, so this test is considered extremely useful for confirming a diagnosis of this type of arthritis.
RF alone cannot be used for diagnosis of rheumatoid arthritis. Around 15% to 20% of patients with rheumatoid arthritis never have RF positivity, and 2% to 10% of healthy persons are RF positive. Hence, positive RF alone does not confirm rheumatoid arthritis and negative RF does not exclude it.
RF is detected in a wide variety of rheumatic (Cryoglobulinemia, Sjogren’s Syndrome, SLE, Systemic Sclerosis) and nonrheumatic conditions (infections, malignancy, bacterial endocarditis)
The gold standard method for RF testing is nephelometry. Other common methods are turbidometry and latex agglutination. The normal value of RF is below 40 IU.ml.
Anti-cyclic citrullinated peptide (anti-CCP) – Also called anti-citrullinated protein antibodies (ACPA), this test (like the test for rheumatoid factor) looks for the presence of a particular autoantibody that is present in approximately 60-80 percent of people with RA. While most patients with anti-CCP antibodies are also positive for rheumatoid factor, the RF antibody can occur in patients with many other conditions, including an infection. Anti-CCP is more specific for RA and is becoming the preferred test.
Two of the most important clinical uses of this test are its high specificity for the disease and the presence of anti-CCP antibodies in early-phase rheumatoid arthritis. Anti-CCP antibodies can appear in the circulation several years before the onset of rheumatoid arthritis. The presence of anti-CCP antibodies in early disease is highly predictive for more-rapid progression of disease, meaning patients with anti-CCP antibodies have significantly more joint damage than patients without this antibody. Hence, all patients in whom RA is suspected on clinical grounds should be tested for anti-CCP antibody
Antinuclear antibody (ANA) – Commonly found in the blood of people who have lupus, ANAs (abnormal antibodies directed against the cells’ nuclei) can also suggest the presence ofpolymyositis, scleroderma, Sjogren’s syndrome, mixed connective tissue disease or rheumatoid arthritis. Antinuclear antibodies (ANAs) have been detected in the serum of patients with many rheumatic and nonrheumatic diseases as well as in healthy persons.
The most common methods used to detect and characterize these ANAs include immunofluorescence microscopy (IIIF), enzyme-linked immunosorbent assay (ELISA).
There are different types of ANAs based on their target antigen. The staining pattern seen on indirect immunofluorescence (IIF) gives some indication of the specificity of the antibodies. ). Identification of the specificity for extractable nuclear antigens (ENA) is warranted because this can further differentiate between the distinct types of autoimmune connective tissue diseases. Hence, a positive ANA test should be followed by an ANA-Western Blot or RNA and anti-DNA antibodies assay.
Anti-DNA Antibodies- Antibodies to dsDNA are often measured in SLE and are commonly referred to as anti-DNA antibodies. They are very useful in the diagnosis of SLE and assessment of disease activity, and they are associated with lupus nephritis.The most commonly used techniques for measuring anti-dsDNA antibodies are ELISA and immunofluorescence. Not all patients with SLE have positive anti-dsDNA antibodies; therefore, a negative test does not exclude the diagnosis of SLE.
Complete blood count—a general test that measures the amounts of various blood cells—can provide clues to the presence of inflammation, which tends to increase levels of white blood cells and platelets and decrease the amount of red blood cells.
Erythrocyte sedimentation rate (ESR)- ESR refers to the rate at which red blood cells, or erythrocytes, settle at the bottom of a special tube to form a sediment. The ESR is increased in many rheumatologic disorders.  ESR can be greatly influenced by the shape and number of red blood cells as well as other plasma constituents. ESR increases steadily with age, and the upper limit varies with sex; hence, ESR is difficult to interpret compared to CRP.
C-reactive protein (CRP) – CRP is a substance produced by the liver in response to inflammation. CRP levels are an even better indication than ESR of the amount of inflammation present. In people with rheumatoid arthritis, if the CRP is high, it suggests that there is significant inflammation or injury in the body.
Both CRP and ESR levels are used to monitor disease activity and to monitor how well someone is responding to treatment.

Blood chemistry screen –
                Liver function test, blood urea and creatinine and serum lipids are general tests that can help to identify problems in the body’s organs such as liver, heart and kidney. Certain types of inflammatory arthritis, including RA, can affect kidney function, as can certain arthritis drugs.
Uric acid- The blood test for this substance is primarily used to detect gout, a form of arthritis that typically affects the joints of the feet.  Uric acid levels may also be elevated in some kidney disorders and other conditions that are associated with excessive tissue destruction.
Urine Tests
Several different tests may be done on a urine sample to determine its contents. The tests show whether the urine contains red blood cells, protein, or a variety of abnormal substances, none of which is normally present. The detection of these substances may indicate kidney damage in certain rheumatic diseases, such as lupus.
A 24-hour urine test evaluates all the urine collected over a 24-hour period. Sometimes the creatinine passed in a 24-hour urine specimen is measured to provide a clearer picture of kidney function than the creatinine blood test. Uric acid, calcium, and protein tests sometimes must also be done on a 24-hour sample.
Joint fluid tests – Inserting a needle into a joint and aspirating, or removing, synovial fluid from it can provide a doctor with valuable information. (Synovial fluid is the slippery fluid that fills a joint, providing smoother movement.). It generally causes no more pain than drawing blood. An examination of the fluid may reveal what is causing the inflammation, such as uric acid crystals, a sure sign of gout, or bacteria, a sign of infection.
In addition, aspiration sometimes can relieve the pain of a badly swollen joint. Many a times a corticosteroid is injected through the needle to reduce inflammation for an extended period of time-up to three months in many cases and for months or years in a few instances.
HLA tissue typing – Human leukocyte antigen (HLA) tissue typing tests detect the presence of certain "genetic markers" or traits in the blood. For example, B-27 is a genetic marker that nearly always is present in people with ankylosing spondylitis (a disease involving inflammation of the spine and sacroiliac joint) and Reiter’s syndrome (a disease involving inflammation of the urethra, eyes, and joints). This test also is positive in five to 10 percent of the healthy population.

Other Special Tests:
Complement tests- This test involves the reaction of antibodies with antigens. These tests usually are reserved for diagnosing or monitoring people with active lupus. Those people with lupus frequently have lower-than-normal amounts of complement, especially if the kidneys are affected.
Muscle enzyme tests- (CPK, aldolase) measure the amount of muscle damage. In some rheumatic diseases, damaged muscles release certain enzymes into the blood.

Biopsies
To help confirm a diagnosis or check on the status of disease activity, a doctor may order a biopsy, or removal small piece of tissue, to be examined under a microscope. Three of the most common biopsies include skin, muscle, and kidney biopsies. Skin biopsies usually are done to aid the diagnosis of lupus; vasculitis (inflammation of blood vessels); psoriatic arthritis (inflammation of joints and scaly, inflamed skin), or other forms of arthritis that involve the skin.
Muscle biopsies are similar to skin biopsies, and are used to look for signs of damage to the muscle fibers. This information can help confirm the diagnosis of polymyositis or vasculitis.
Kidney biopsies usually are done to check for signs of damage from a disease such as lupus. Other biopsies which are done on a less frequent basis are synovial, lung, salivary gland, and blood vessel biopsies. Liver biopsies occasionally are done to check for signs of damage in people receiving methotrexate for rheumatoid arthritis.

Lab Tests Limitations
Despite their many benefits, lab tests have their limitations. Some may show negative results even when a person has the disease being tested for; others may be positive in people who don’t have – or may never develop – a particular disease. Not all forms of arthritis can be confirmed by lab tests. Other tests, including X-rays, various types of angiograms (studies of blood vessels) and magnetic resonance imaging (MRI), may be required to diagnose osteoarthritis, determine the cause of chronic back pain, or examine internal organs affected by some forms of arthritis.Even so, lab tests are essential to the diagnostic and treatment process. The right tests, along with your doctor’s own observations and your participation in the process, can help you get the safest and most effective treatment for your disease.

Join the Conversation

354 Comments

  1. Thank you, I have recently been searching for information approximately this topic for a while and yours is the best I have came upon so far. However, what concerning the conclusion? Are you sure about the source?

  2. You really make it seem so easy with your presentation but I find this topic to be really something which I think I would never understand. It seems too complicated and very broad for me. I am looking forward for your next post, I will try to get the hang of it!

  3. It is appropriate time to make some plans for the future and it is time to be happy. I have read this post and if I could I want to suggest you few interesting things or advice. Perhaps you could write next articles referring to this article. I wish to read more things about it!

  4. Can I just say what a relief to discover somebody who truly knows what they’re talking about online. You certainly know how to bring an issue to light and make it important. More people must read this and understand this side of the story. I was surprised that you aren’t more popular since you certainly have the gift.

  5. I’ve been exploring for a little for any high-quality articles or blog posts in this kind of space . Exploring in Yahoo I finally stumbled upon this site. Reading this info So i’m glad to exhibit that I have a very good uncanny feeling I found out exactly what I needed. I so much surely will make certain to don?t overlook this site and give it a look on a constant basis.

  6. Howdy, i read your blog occasionally and i own a similar one and i was just wondering if you get a lot of spam comments? If so how do you reduce it, any plugin or anything you can suggest? I get so much lately it’s driving me insane so any help is very much appreciated.

  7. Hello there, simply turned into aware of your blog thru Google, and found that it is really informative. I’m gonna watch out for brussels. I will appreciate in case you continue this in future. Lots of other folks can be benefited from your writing. Cheers!

  8. Hey there! This post couldn’t be written any better! Reading this post reminds me of my good old room mate! He always kept talking about this. I will forward this article to him. Pretty sure he will have a good read. Thank you for sharing!

  9. Hmm it seems like your site ate my first comment (it was extremely long) so I guess I’ll just sum it up what I had written and say, I’m thoroughly enjoying your blog. I as well am an aspiring blog blogger but I’m still new to the whole thing. Do you have any recommendations for novice blog writers? I’d genuinely appreciate it.

  10. Thanks for the marvelous posting! I actually enjoyed reading it, you could be a great author. I will be sure to bookmark your blog and will eventually come back in the foreseeable future. I want to encourage yourself to continue your great job, have a nice afternoon!

  11. hey there and thank you for your information I’ve definitely picked up anything new from right here. I did however expertise some technical issues using this site, since I experienced to reload the site many times previous to I could get it to load properly. I had been wondering if your hosting is OK? Not that I am complaining, but sluggish loading instances times will often affect your placement in google and can damage your high quality score if advertising and marketing with Adwords. Anyway I’m adding this RSS to my e-mail and can look out for a lot more of your respective fascinating content. Make sure you update this again soon.

  12. Thank you for another great article. Where else may anyone get that kind of information in such a perfect way of writing? I have a presentation next week, and I am at the look for such information.

  13. You’re so awesome! I don’t suppose I have read something like this before. So great to find someone with some unique thoughts on this topic. Really.. thank you for starting this up. This site is something that is needed on the web, someone with some originality!

  14. Woah! I’m really loving the template/theme of this website. It’s simple, yet effective. A lot of times it’s challenging to get that “perfect balance” between superb usability and visual appeal. I must say you have done a fantastic job with this. In addition, the blog loads extremely fast for me on Chrome. Outstanding Blog!

  15. Wonderful goods from you, man. I’ve understand your stuff previous to and you’re just too magnificent. I really like what you’ve acquired here, really like what you’re stating and the way in which you say it. You make it entertaining and you still take care of to keep it smart. I cant wait to read far more from you. This is actually a terrific site.

  16. Howdy excellent blog! Does running a blog like this take a lot of work? I have virtually no knowledge of computer programming but I was hoping to start my own blog soon. Anyway, if you have any recommendations or tips for new blog owners please share. I know this is off topic nevertheless I just needed to ask. Cheers!

  17. I think this is one of the most significant information for me. And i’m glad reading your article. But wanna remark on few general things, The site style is great, the articles is really nice : D. Good job, cheers

  18. Greetings from Florida! I’m bored to death at work so I decided to check out your website on my iphone during lunch break. I really like the info you present here and can’t wait to take a look when I get home. I’m amazed at how quick your blog loaded on my cell phone .. I’m not even using WIFI, just 3G .. Anyhow, excellent site!

  19. With havin so much written content do you ever run into any problems of plagorism or copyright violation? My website has a lot of completely unique content I’ve either created myself or outsourced but it looks like a lot of it is popping it up all over the web without my agreement. Do you know any techniques to help stop content from being ripped off? I’d genuinely appreciate it.

  20. It is appropriate time to make a few plans for the longer term and it is time to be happy. I have read this submit and if I may just I wish to suggest you few interesting things or advice. Perhaps you could write next articles relating to this article. I wish to read more things approximately it!

  21. Hey there this is kinda of off topic but I was wondering if blogs use WYSIWYG editors or if you have to manually code with HTML. I’m starting a blog soon but have no coding experience so I wanted to get advice from someone with experience. Any help would be greatly appreciated!

  22. Hello there, just became aware of your blog through Google, and found that it is really informative. I’m gonna watch out for brussels. I will appreciate if you continue this in future. Many people will be benefited from your writing. Cheers!

  23. It’s a shame you don’t have a donate button! I’d certainly donate to this superb blog! I suppose for now i’ll settle for book-marking and adding your RSS feed to my Google account. I look forward to fresh updates and will talk about this site with my Facebook group. Chat soon!

  24. It is appropriate time to make a few plans for the future and it is time to be happy. I have read this publish and if I may just I wish to suggest you few interesting things or advice. Perhaps you could write next articles referring to this article. I want to read more things approximately it!

  25. Хотите получить идеально ровный пол без лишних затрат? Обратитесь к профессионалам на сайте styazhka-pola24.ru! Мы предоставляем услуги по стяжке пола м2 по доступной стоимости, а также устройству стяжки пола под ключ в Москве и области.

  26. Нужна механизированная штукатурка стен в Москве, но вы не знаете, как выбрать подрядчика? Обратитесь к нам на сайт mehanizirovannaya-shtukaturka-moscow.ru! Мы предлагаем услуги по машинной штукатурке стен любой площади и сложности, а также гарантируем доступные цены и высокое качество работ.

  27. Do you have a spam issue on this website; I also am a blogger, and I was curious about your situation; many of us have created some nice procedures and we are looking to trade solutions with other folks, be sure to shoot me an e-mail if interested.

  28. Thanks for one’s marvelous posting! I actually enjoyed reading it, you might be a great author.I will ensure that I bookmark your blog and definitely will come back someday. I want to encourage you to continue your great posts, have a nice weekend!

  29. My spouse and I stumbled over here from a different website and thought I may as well check things out. I like what I see so now i am following you. Look forward to looking at your web page for a second time.

  30. My brother suggested I might like this website. He was totally right. This post actually made my day. You cann’t imagine just how much time I had spent for this information! Thanks!

  31. Hi there! This post couldn’t be written any better! Reading this post reminds me of my old room mate! He always kept talking about this. I will forward this post to him. Pretty sure he will have a good read. Thank you for sharing!

  32. You’re so cool! I don’t think I’ve read anything like this before. So good to find somebody with some original thoughts on this issue. Really.. thank you for starting this up. This site is something that is needed on the web, someone with some originality!

  33. Have you ever thought about publishing an e-book or guest authoring on other sites? I have a blog centered on the same information you discuss and would really like to have you share some stories/information. I know my visitors would value your work. If you are even remotely interested, feel free to send me an e-mail.

  34. It’s actually a nice and helpful piece of information. I’m glad that you simply shared this helpful info with us. Please stay us informed like this. Thanks for sharing.

  35. Hi there! This article couldn’t be written any better! Reading through this post reminds me of my previous roommate! He constantly kept talking about this. I will forward this article to him. Pretty sure he’ll have a good read. Thanks for sharing!

  36. Hi there, i read your blog occasionally and i own a similar one and i was just wondering if you get a lot of spam responses? If so how do you stop it, any plugin or anything you can suggest? I get so much lately it’s driving me mad so any help is very much appreciated.

  37. I think this is one of the most significant information for me. And i’m glad reading your article. But want to remark on few general things, The website style is perfect, the articles is really excellent : D. Good job, cheers

  38. Hi, i read your blog occasionally and i own a similar one and i was just wondering if you get a lot of spam responses? If so how do you prevent it, any plugin or anything you can advise? I get so much lately it’s driving me insane so any assistance is very much appreciated.

  39. Terrific article! This is the type of information that are supposed to be shared around the web. Disgrace on the seek engines for not positioning this publish upper! Come on over and discuss with my site . Thank you =)

  40. Wow that was strange. I just wrote an very long comment but after I clicked submit my comment didn’t show up. Grrrr… well I’m not writing all that over again. Anyway, just wanted to say great blog!

  41. Hello there, simply was aware of your blog thru Google, and found that it is really informative. I’m gonna watch out for brussels. I will appreciate in case you continue this in future. A lot of folks might be benefited from your writing. Cheers!

  42. Terrific article! This is the type of information that are meant to be shared around the internet. Disgrace on the seek engines for not positioning this publish upper! Come on over and talk over with my web site . Thank you =)

  43. Hey very nice blog!! Guy .. Beautiful .. Superb .. I will bookmark your website and take the feeds also? I am satisfied to find numerous useful information here in the submit, we’d like develop more strategies in this regard, thank you for sharing. . . . . .

  44. Do you mind if I quote a couple of your posts as long as I provide credit and sources back to your webpage? My blog site is in the very same area of interest as yours and my visitors would definitely benefit from a lot of the information you present here. Please let me know if this okay with you. Cheers!

  45. When I originally commented I clicked the “Notify me when new comments are added” checkbox and now each time a comment is added I get four emails with the same comment. Is there any way you can remove me from that service? Thanks!

  46. My brother suggested I would possibly like this blog. He used to be totally right. This post actually made my day. You cann’t believe just how so much time I had spent for this information! Thank you!

  47. Pretty nice post. I just stumbled upon your blog and wanted to say that I have really enjoyed browsing your blog posts. In any case I’ll be subscribing to your feed and I hope you write again soon!

  48. Hi there! I know this is somewhat off-topic but I had to ask. Does operating a well-established blog like yours take a massive amount work? I’m completely new to blogging but I do write in my diary on a daily basis. I’d like to start a blog so I can share my own experience and views online. Please let me know if you have any ideas or tips for new aspiring bloggers. Appreciate it!

  49. Good day! Do you know if they make any plugins to help with SEO? I’m trying to get my blog to rank for some targeted keywords but I’m not seeing very good results. If you know of any please share. Thanks!

  50. I used to be recommended this blog by way of my cousin. I am now not sure whether this publish is written by means of him as no one else recognise such special approximately my problem. You are wonderful! Thank you!

  51. I have been surfing online more than three hours today, yet I never found any interesting article like yours. It’s pretty worth enough for me. In my opinion, if all site owners and bloggers made good content as you did, the internet will be much more useful than ever before.

  52. Hi there would you mind stating which blog platform you’re working with? I’m looking to start my own blog in the near future but I’m having a tough time making a decision between BlogEngine/Wordpress/B2evolution and Drupal. The reason I ask is because your design seems different then most blogs and I’m looking for something completely unique. P.S Apologies for getting off-topic but I had to ask!

  53. Have you ever considered about including a little bit more than just your articles? I mean, what you say is fundamental and all. Nevertheless think about if you added some great visuals or video clips to give your posts more, “pop”! Your content is excellent but with images and video clips, this site could undeniably be one of the very best in its niche. Terrific blog!

  54. My spouse and I stumbled over here coming from a different page and thought I might check things out. I like what I see so now i am following you. Look forward to exploring your web page again.

  55. I’d like to thank you for the efforts you have put in writing this blog. I am hoping to view the same high-grade blog posts from you in the future as well. In fact, your creative writing abilities has inspired me to get my own blog now 😉

  56. Hi would you mind letting me know which hosting company you’re working with? I’ve loaded your blog in 3 completely different web browsers and I must say this blog loads a lot quicker then most. Can you suggest a good internet hosting provider at a honest price? Thank you, I appreciate it!

  57. You really make it seem so easy together with your presentation however I find this topic to be really something which I feel I would never understand. It kind of feels too complicated and very vast for me. I am looking forward on your next publish, I will try to get the grasp of it!

  58. fantastic post, very informative. I’m wondering why the other experts of this sector do not understand this. You should continue your writing. I am sure, you have a huge readers’ base already!

  59. I like the valuable information you supply in your articles. I will bookmark your weblog and test again here frequently. I am quite certain I will be informed a lot of new stuff right here! Good luck for the following!

  60. Thanks for the marvelous posting! I really enjoyed reading it, you can be a great author. I will be sure to bookmark your blog and will eventually come back from now on. I want to encourage continue your great writing, have a nice weekend!

  61. Hello there! This is kind of off topic but I need some help from an established blog. Is it tough to set up your own blog? I’m not very techincal but I can figure things out pretty fast. I’m thinking about setting up my own but I’m not sure where to start. Do you have any points or suggestions? With thanks

  62. Someone necessarily lend a hand to make significantly articles I would state. This is the first time I frequented your web page and so far? I amazed with the research you made to create this actual post amazing. Great process!

  63. Yesterday, while I was at work, my sister stole my iphone and tested to see if it can survive a 25 foot drop, just so she can be a youtube sensation. My iPad is now broken and she has 83 views. I know this is completely off topic but I had to share it with someone!

  64. Woah! I’m really enjoying the template/theme of this site. It’s simple, yet effective. A lot of times it’s tough to get that “perfect balance” between superb usability and visual appearance. I must say you have done a awesome job with this. In addition, the blog loads very fast for me on Opera. Exceptional Blog!

  65. Please let me know if you’re looking for a article writer for your site. You have some really great posts and I believe I would be a good asset. If you ever want to take some of the load off, I’d absolutely love to write some material for your blog in exchange for a link back to mine. Please send me an e-mail if interested. Many thanks!

  66. Hi, Neat post. There is a problem together with your web site in internet explorer, may check this? IE still is the marketplace leader and a big component of folks will miss your great writing due to this problem.

  67. Heya terrific blog! Does running a blog like this take a great deal of work? I have virtually no expertise in programming but I was hoping to start my own blog soon. Anyway, if you have any recommendations or tips for new blog owners please share. I know this is off topic nevertheless I just needed to ask. Thanks!

  68. I will right away grab your rss as I can not in finding your email subscription link or newsletter service. Do you have any? Please allow me recognize so that I may just subscribe. Thanks.

  69. Hello there! This article couldn’t be written any better! Looking at this post reminds me of my previous roommate! He constantly kept talking about this. I will forward this article to him. Pretty sure he’ll have a very good read. Many thanks for sharing!

  70. Hey There. I found your blog the use of msn. This is a very smartly written article. I will be sure to bookmark it and come back to read more of your useful information. Thank you for the post. I will definitely comeback.

  71. Please let me know if you’re looking for a article writer for your site. You have some really great posts and I think I would be a good asset. If you ever want to take some of the load off, I’d absolutely love to write some articles for your blog in exchange for a link back to mine. Please blast me an e-mail if interested. Thank you!

  72. I’m impressed, I must say. Rarely do I encounter a blog that’s equally educative and engaging, and let me tell you, you have hit the nail on the head. The issue is something which not enough people are speaking intelligently about. I am very happy that I found this in my search for something relating to this.

  73. I like the valuable information you supply in your articles. I will bookmark your weblog and check again here frequently. I am somewhat certain I will be told plenty of new stuff right here! Good luck for the following!

  74. you are in point of fact a good webmaster. The site loading velocity is incredible. It sort of feels that you are doing any unique trick. In addition, The contents are masterpiece. you have performed a wonderful activity in this topic!

  75. you are in reality a good webmaster. The site loading speed is incredible. It kind of feels that you are doing any unique trick. Moreover, The contents are masterpiece. you have performed a great task in this topic!

  76. Thank you for any other magnificent article. Where else may anyone get that kind of information in such a perfect method of writing? I have a presentation next week, and I am at the look for such information.

  77. Magnificent goods from you, man. I’ve understand your stuff previous to and you’re just too fantastic. I really like what you’ve acquired here, really like what you’re stating and the way in which you say it. You make it entertaining and you still take care of to keep it sensible. I cant wait to read far more from you. This is actually a wonderful website.

  78. Unquestionably believe that which you stated. Your favorite justification appeared to be on the internet the simplest thing to be aware of. I say to you, I definitely get irked while people consider worries that they plainly do not know about. You managed to hit the nail upon the top and also defined out the whole thing without having side effect , people can take a signal. Will likely be back to get more. Thanks

  79. Can I just say what a relief to find somebody that actually knows what they’re talking about on the internet. You definitely know how to bring an issue to light and make it important. More people have to read this and understand this side of the story. I was surprised that you’re not more popular since you certainly have the gift.

  80. With havin so much content and articles do you ever run into any problems of plagorism or copyright violation? My site has a lot of exclusive content I’ve either authored myself or outsourced but it looks like a lot of it is popping it up all over the web without my agreement. Do you know any techniques to help protect against content from being ripped off? I’d truly appreciate it.

  81. Undeniably consider that that you stated. Your favourite justification appeared to be at the internet the simplest thing to be aware of. I say to you, I definitely get irked even as other people consider concerns that they plainly do not understand about. You controlled to hit the nail upon the top as welland also defined out the whole thing with no need side effect , other people can take a signal. Will likely be back to get more. Thank you

  82. Hi there I am so thrilled I found your web site, I really found you by mistake, while I was browsing on Aol for something else, Regardless I am here now and would just like to say thank you for a marvelous post and a all round enjoyable blog (I also love the theme/design), I dont have time to look over it all at the minute but I have book-marked it and also added in your RSS feeds, so when I have time I will be back to read a great deal more, Please do keep up the excellent b.

  83. Great goods from you, man. I’ve bear in mind your stuff prior to and you’re simply too fantastic. I really like what you’ve acquired here, really like what you’re stating and the way during which you assert it. You are making it entertaining and you still take care of to stay it sensible. I can not wait to read far more from you. This is actually a wonderful website.

  84. Have you ever considered about including a little bit more than just your articles? I mean, what you say is valuable and all. However think about if you added some great graphics or video clips to give your posts more, “pop”! Your content is excellent but with images and video clips, this website could certainly be one of the very best in its niche. Very good blog!

  85. I loved as much as you will receive carried out right here. The sketch is tasteful, your authored subject matter stylish. nonetheless, you command get bought an impatience over that you wish be delivering the following. unwell unquestionably come further formerly again since exactly the same nearly a lot often inside case you shield this increase.

  86. Hi there to every one, it’s really a nice for me to pay a visit this website, it consists of priceless Information.

  87. My coder is trying to persuade me to move to .net from PHP. I have always disliked the idea because of the expenses. But he’s tryiong none the less. I’ve been using Movable-type on numerous websites for about a year and am anxious about switching to another platform. I have heard very good things about blogengine.net. Is there a way I can transfer all my wordpress content into it? Any kind of help would be really appreciated!

  88. Hi there just wanted to give you a quick heads up. The text in your post seem to be running off the screen in Ie. I’m not sure if this is a format issue or something to do with web browser compatibility but I thought I’d post to let you know. The layout look great though! Hope you get the problem solved soon. Cheers

  89. First off I want to say wonderful blog! I had a quick question in which I’d like to ask if you don’t mind. I was curious to know how you center yourself and clear your thoughts before writing. I have had a difficult time clearing my mind in getting my thoughts out. I do enjoy writing but it just seems like the first 10 to 15 minutes are generally wasted just trying to figure out how to begin. Any suggestions or tips? Thank you!

  90. Hey there would you mind letting me know which hosting company you’re utilizing? I’ve loaded your blog in 3 completely different internet browsers and I must say this blog loads a lot quicker then most. Can you suggest a good internet hosting provider at a honest price? Thanks a lot, I appreciate it!

Leave a comment

Your email address will not be published. Required fields are marked *