Antinuclear Antibody, Rheumatoid Factor, and Cyclic-Citrullinated Peptide Testing for the Evaluation of Musculoskeletal Complaints in Pediatric Populations
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
Keywords: antinuclear antibody | cyclic-citrullinated peptide | juvenile idiopathic arthritis | musculoskeletal pain | negative predictive value | pediatric systemic lupus erythematosus | positive predictive value | rheumatoid factor | test performance | test sensitivity | test specificity | test utility | clinical testing
- Wong KO, Bond K, Homik J, et al. Antinuclear Antibody, Rheumatoid Factor, and Cyclic-Citrullinated Peptide Tests for Evaluating Musculoskeletal Complaints in Children. Comparative Effectiveness Review No. 50 (Prepared by the University of Alberta Evidence-based Practice Center under Contract No. HHSA 290-2007-10021-I). Rockville, MD: Agency for Healthcare Research and Quality; March 2012. AHRQ Publication No. 12-EHC015-EF. Available at www.effectivehealthcare.ahrq.gov/anatest.cfm.
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