Antinuclear Antibody, Rheumatoid Factor, and Cyclic-Citrullinated Peptide Testing for the Evaluation of Musculoskeletal Complaints in Pediatric Populations
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.
Keywords: musculoskeletal pain | nonrheumatic cause | sprain | strain | overuse | normal body growth | rheumatic cause | juvenile idiopathic arthritis | pediatric systemic lupus erythematosus | spondyloarthropathy | enthesitis-related arthritis | juvenile ankylosing spondylitis | reactive arthritis | acute rheumatic fever | Henoch-Schönlein purpura
- 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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