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

Slide: 19 of 23

Report Findings: Clinical Bottom Line Regarding the Utility of Clinical Testing

The RF test may have a potential application in confirming a suspected clinical diagnosis of JIA (i.e., diagnosis based on a comprehensive patient history and physical examination). One retrospective cohort study examined records of 437 pediatric hospital patients with MSK pain who had an RF test. They found very limited utility of the RF test for diagnosing JIA with a positive predictive value of 45 percent and a negative predictive value of 77 percent (sensitivity = 4.8%; specificity = 98%). Strength of Evidence: Low

The evidence is insufficient to evaluate the sensitivity and specificity of most test-disease combinations. Thus, the test performance of the ANA or CCP antibody tests in children with undiagnosed MSK pain is unknown, as is the performance of the RF test for diagnosing pSLE. Strength of Evidence: Insufficient


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