Testing for Rheumatological Diagnoses in Children

Overview

Journal Eur Paediatr Rev

Publisher Touch Briefings

Date 2011 Nov 8

PMID 22059094

Citations 2

Authors

Judith A Smith

Affiliations

Soon will be listed here.

Abstract

Paediatricians often order laboratory and radiological tests to identify children with potential rheumatological disease prior to subspeciality referral. However, the pattern of testing suggests inadequate understanding of their diagnostic utility and limitations. Herein we will address some of the most common rheumatological diagnoses encountered in the subspeciality clinic - juvenile idiopathic arthritis (JIA), juvenile spondyloarthritis (JSpA) and systemic lupus erythematosus (SLE), and related connective tissue diseases - and the tests most frequently ordered to diagnose them: anti-nuclear antibodies (ANA), rheumatoid factor (RF), human leukocyte antigen (HLA)-B27 and radiological tests. This article will highlight the sensitivity, specificity and positive predictive value of the tests. In general, none of these tests were appropriate to use as rheumatological 'screens', as no individual test was diagnostic. Specific tests should be ordered only when there is a high clinical index of suspicion for a particular disease entity. Greater understanding of a test's diagnostic utility should decrease unnecessary testing, anxiety and expense and aid in interpretation.

Citing Articles

Use of Rheumatology Laboratory Studies Among Primary Pediatricians.

Correll C, Spector L, Zhang L, Binstadt B, Vehe R Clin Pediatr (Phila). 2016; 55(14):1279-1288.

PMID: 26755273 PMC: 5233599. DOI: 10.1177/0009922815624902.

Utility of immunologic testing in suspected rheumatologic disease.

Bhagat M, Sehra S, Shahane A, Kwan M Curr Allergy Asthma Rep. 2013; 14(1):405.

PMID: 24370946 DOI: 10.1007/s11882-013-0405-5.

References

Feletar M, Ibanez D, Urowitz M, Gladman D . The impact of the 1997 update of the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus: what has been changed?. Arthritis Rheum. 2003; 48(7):2067-9. DOI: 10.1002/art.11167. View

Klauser A, Bollow M, Calin A, Frauscher F, Kainberger F, Moncayo R . Workshop report: clinical diagnosis and imaging of sacroiliitis, Innsbruck, Austria, October 9, 2003. J Rheumatol. 2004; 31(10):2041-7. View

Hilario M, Len C, Roja S, Terreri M, Almeida G, Andrade L . Frequency of antinuclear antibodies in healthy children and adolescents. Clin Pediatr (Phila). 2004; 43(7):637-42. DOI: 10.1177/000992280404300709. View

Denardo B, Tucker L, Miller L, Szer I, Schaller J . Demography of a regional pediatric rheumatology patient population. Affiliated Children's Arthritis Centers of New England. J Rheumatol. 1994; 21(8):1553-61. View

Manners P, Bower C . Worldwide prevalence of juvenile arthritis why does it vary so much?. J Rheumatol. 2002; 29(7):1520-30. View

Petty R, Southwood T, Baum J, Bhettay E, Glass D, Manners P . Revision of the proposed classification criteria for juvenile idiopathic arthritis: Durban, 1997. J Rheumatol. 1998; 25(10):1991-4. View

McGhee J, Burks F, Sheckels J, Jarvis J . Identifying children with chronic arthritis based on chief complaints: absence of predictive value for musculoskeletal pain as an indicator of rheumatic disease in children. Pediatrics. 2002; 110(2 Pt 1):354-9. DOI: 10.1542/peds.110.2.354. View

Hoving J, Buchbinder R, Hall S, Lawler G, Coombs P, McNealy S . A comparison of magnetic resonance imaging, sonography, and radiography of the hand in patients with early rheumatoid arthritis. J Rheumatol. 2004; 31(4):663-75. View

Eichenfield A, Athreya B, Doughty R, Cebul R . Utility of rheumatoid factor in the diagnosis of juvenile rheumatoid arthritis. Pediatrics. 1986; 78(3):480-4. View

10.

Byrne P, Williams B, Pritchard M . Minocycline-related lupus. Br J Rheumatol. 1994; 33(7):674-6. DOI: 10.1093/rheumatology/33.7.674. View

11.

Cabral D, Petty R, Fung M, Malleson P . Persistent antinuclear antibodies in children without identifiable inflammatory rheumatic or autoimmune disease. Pediatrics. 1992; 89(3):441-4. View

12.

Malleson P, Mackinnon M, Sailer-Hoeck M, Spencer C . Review for the generalist: The antinuclear antibody test in children - When to use it and what to do with a positive titer. Pediatr Rheumatol Online J. 2010; 8:27. PMC: 2987328. DOI: 10.1186/1546-0096-8-27. View

13.

Newkirk M . Rheumatoid factors: host resistance or autoimmunity?. Clin Immunol. 2002; 104(1):1-13. DOI: 10.1006/clim.2002.5210. View

14.

Zimmerman S, Ware R . Clinical significance of the antinuclear antibody test in selected children with idiopathic thrombocytopenic purpura. J Pediatr Hematol Oncol. 1997; 19(4):297-303. DOI: 10.1097/00043426-199707000-00006. View

15.

Mason T, Reed A, Nelson A, Thomas K, Patton A, Hoffman A . Frequency of abnormal hand and wrist radiographs at time of diagnosis of polyarticular juvenile rheumatoid arthritis. J Rheumatol. 2002; 29(10):2214-8. View

16.

Van Rossum M, van Soesbergen R, de Kort S, ten Cate R, Zwinderman A, de Jong B . Anti-cyclic citrullinated peptide (anti-CCP) antibodies in children with juvenile idiopathic arthritis. J Rheumatol. 2003; 30(4):825-8. View

17.

Fawcett P, Rose C, Gibney K, Emerich M, Athreya B, Doughty R . Use of ELISA to measure antinuclear antibodies in children with juvenile rheumatoid arthritis. J Rheumatol. 1999; 26(8):1822-6. View

18.

Rosenberg A . Longitudinal analysis of a pediatric rheumatology clinic population. J Rheumatol. 2005; 32(10):1992-2001. View

19.

Oen K . Comparative epidemiology of the rheumatic diseases in children. Curr Opin Rheumatol. 2000; 12(5):410-4. DOI: 10.1097/00002281-200009000-00010. View

20.

Wihlborg C, Babyn P, Ranson M, Laxer R . Radiologic mimics of juvenile rheumatoid arthritis. Pediatr Radiol. 2001; 31(5):315-26. DOI: 10.1007/s002470100431. View