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

Slide: 14 of 23

Clinical Questions Addressed by the CER (3 of 3)

In preparing the report on which this continuing medical education activity is based, the authors aimed to answer five Key Questions (KQs). KQs 4 and 5 are listed below:

KQ 4. Accuracy modifiers

KQ 4.1. In children and adolescents aged 18 years or less with undiagnosed MSK pain and/or joint swelling, do age, sex, race/ethnicity, comorbidities, and recent infections modify the diagnostic performance (sensitivity, specificity, and positive and negative predictive values) of ANA, RF, and CCP for pSLE when compared with a clinical diagnosis?

KQ 4.2. In children and adolescents aged 18 years or younger with undiagnosed MSK pain and/or joint swelling, do age, sex, race/ethnicity, comorbidities, and recent infections modify the diagnostic performance (sensitivity, specificity, and positive and negative predictive values) of ANA, RF, and CCP for JIA when compared with a clinical diagnosis?

KQ 5. Clinical impacts of test results

KQ 5. In children and adolescents aged 18 years or younger with undiagnosed MSK pain and/or joint swelling, do ANA, RF, and CCP test results affect referral decisions, additional tests ordered, clinical management, and patient and parent anxiety due to the clinical uncertainty and additional tests?

Abbreviations:

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