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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: Juvenile Idiopathic Arthritis

Juvenile idiopathic arthritis (JIA) is the most common chronic inflammatory disease of children, affecting approximately 1 in 1,000 children. In adults with suspected rheumatoid arthritis, tests for rheumatoid factor (RF) and, more recently, cyclic-citrullinated peptide (CPP) antibodies are frequently requested as part of the diagnostic workup. Although there is limited evidence supporting the usefulness of the RF and CCP tests in children, they are often ordered as part of the diagnostic evaluation of a child suspected to have JIA. Without effective treatment, JIA can progress and cause damage to cartilage, bone, and soft tissues and may lead to severe disability and functional loss and, in rare cases, to organ failure and death. Although early diagnosis and treatment may reduce the progression of the disease and induce remission, only a minority of patients experience complete resolution of JIA before adulthood.