A new clinician research summary from AHRQ’s Effective Healthcare Program provides an overview of existing evidence on how well serological tests (antinuclear antibody, rheumatoid factor, and cyclic-citrullinated peptide) determine if undiagnosed musculoskeletal (MSK) pain in children and adolescents is due to inflammatory arthritis or more common causes such as trauma, overuse, and normal bone growth. The occurrence of MSK pain has increased over the past 20 years and varies with age and gender. However, only about 3 percent of cases are due to a serious inflammatory disease. Research on the performance of these tests to detect rare rheumatic causes of MSK pain in children does not provide enough evidence to support the broad use of serological tests to diagnose children. The tests are potentially useful only to support a clinical assessment that suggests the presence of inflammatory arthritis or a connective tissue disease. The clinician summary is also accompanied by a CME/CE activity and a faculty slide set. These materials are based on the research review, Antinuclear Antibody, Rheumatoid Factor, and Cyclic-citrullinated Peptide Tests for the Evaluation of Musculoskeletal Complaints in Pediatric Populations, support discussions of options with patients and assists in decisionmaking along with consideration of a patient’s values and preferences.
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Antinuclear Antibody, Rheumatoid Factor, and Cyclic-Citrullinated Peptide Tests for Evaluating Musculoskeletal Complaints in Children - Executive Summary | AHRQ Effective Health Care Program
Executive Summary – Mar. 7, 2012
Antinuclear Antibody, Rheumatoid Factor, and Cyclic-Citrullinated Peptide Tests for Evaluating Musculoskeletal Complaints in Children
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Table of Contents
- Background
- Key Questions
- Methods
- Results
- Summary
- Conclusion
- Future Research
- References
- Full Report
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Background
Musculoskeletal (MSK) pain is common in children and adolescents, with an estimated prevalence ranging from 2 to 50 percent.1 MSK pain can affect physical, psychological, and social function and often prompts consultation with a physician.2 However, MSK pain is often nonspecific, which can make it difficult to arrive at an accurate diagnosis.3,4MSK pain may be due to rheumatic or nonrheumatic causes. Nonrheumatic causes are more common, generally benign, and most often attributable to trauma, overuse, and normal bone growth.5 Rheumatic causes, such as inflammatory arthritis, are infrequent, generally chronic, and require accurate, timely diagnosis and effective intervention to prevent progression and long-term damage.6 Common rheumatic causes of childhood MSK pain include pediatric systemic lupus erythematosus (pSLE) and juvenile idiopathic arthritis (JIA).
A complete history and physical examination is generally considered to be the best way to make a diagnosis of inflammatory arthritis.3,5 Physicians may request serological tests such as antinuclear antibody (ANA), rheumatoid factor (RF), and cyclic-citrullinated peptide (CCP) when children and adolescents are suspected of having inflammatory arthritis, despite the fact that the diagnostic performance, usefulness, and proper interpretation of these tests are uncertain in pediatric populations.
This comparative effectiveness review summarizes the evidence on the test performance of ANA, RF, or CCP tests for pSLE and JIA in children with undiagnosed MSK pain. The report is intended for a broad audience including primary care physicians who may consider ordering these tests in a child with MSK pain, health payers who provide coverage for these tests, and parents or caregivers who want to know whether these tests can determine if their child does or does not have a particular disease.
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