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

Slide: 22 of 23

Gaps in Knowledge

No studies examined clinically important outcomes—such as the impact of the ANA, RF, and CCP test results on referrals, ordering of additional tests, patient management, and patient and parent anxiety levels. These outcomes may all affect the quality of life and psychological well-being of children and their families. Studies examined children with known disease status rather than a spectrum of children with undiagnosed MSK symptoms, thus providing evidence regarding test performance that likely overestimates sensitivity and specificity values. No studies addressed the patient or clinical characteristics that could modify the accuracy of these serological tests including age, sex, race, history of recent infections, and presence of other characteristics other than MSK pain.

ANA = antinuclear antibody
CCP = cyclic-citrullinated peptide
MSK = musculoskeletal
RF = rheumatoid factor