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Antinuclear Antibody, Rheumatoid Factor, and Cyclic-Citrullinated Peptide Testing for the Evaluation of Musculoskeletal Complaints in Pediatric Populations

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Report Findings: Prevalence of Musculoskeletal Pain Among Healthy Children

The systematic review included a literature search to evaluate the prevalence of musculoskeletal (MSK) pain in children who do not have JIA or pSLE and to determine the rate of false-positive results for the examined tests (i.e., the proportion of otherwise healthy children who have a positive ANA, RF, or CCP test result). The following information was synthesized from this literature review:

  • The prevalence of MSK pain ranged from 2 to 52 percent, varying with age and sex. Up to 30 percent of children and adolescents report episodes of pain lasting over 6 months.
  • In childhood, the prevalence of JIA was 1 per 1,000, and the prevalence of pSLE was 8.8 per 100,000. In children with MSK pain, 97 percent of cases result from noninflammatory causes.
  • Of the 3.3 percent of pediatric cases of MSK pain that result from inflammatory causes: 2.5 percent result from toxic synovitis and 0.8 percent result from inflammatory arthritides.
  •  Recurrence rates of pediatric MSK pain are high and vary by body site. Age, sex, headache, abdominal pain, and combined pain are predictors of recurrence for nontraumatic MSK pain.

Abbreviations:
ANA = antinuclear antibody
CCP = cyclic-citrullinated peptide
JIA = juvenile idiopathic arthritis
pSLE = pediatric systemic lupus erythematosus
RF = rheumatoid factor