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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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Background: Causes of Musculoskeletal Pain

Musculoskeletal (MSK) pain can be divided into nonrheumatic and rheumatic causes. Nonrheumatic causes account for nearly all (approximately 97%) of childhood MSK pain and are generally attributable to benign conditions including minor physical trauma (i.e., sprains and strains), overuse, and normal body growth. In contrast, rheumatic causes, such as inflammatory arthritis, are much less prevalent (approximately 3%), are generally chronic, and require early diagnosis and treatment to prevent progression and long-term disability. Rheumatic causes of childhood MSK pain include pediatric systemic lupus erythematosus (pSLE), JIA, spondyloarthropathies (including enthesitis-related arthritis, juvenile ankylosing spondylitis, and reactive arthritis), acute rheumatic fever, and Henoch-Schönlein purpura. However, MSK pain is not universally present in children with JIA (16% of children with JIA do not report pain) or pSLE.