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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: Using Serological Tests To Diagnose Musculoskeletal Pain

A complete patient history and physical examination is generally considered to be the best way to make a diagnosis of inflammatory arthritis. However, the complaint of musculoskeletal (MSK) pain is often nonspecific and, when combined with a lack of confidence in the MSK physical examination, can make it difficult to arrive at an accurate diagnosis. Hence, physicians may request additional laboratory tests. Ordering of these tests is often due to an erroneous assumption that they can serve as broad screening tests of rheumatic diseases.

Antinuclear antibody, rheumatoid factor, and cyclic-citrullinated peptide (CCP) antibody are autoantibodies that target specific nuclear particles, the Fc portion of immunoglobulin G and CCPs, respectively. Serological tests for these autoantibodies may be ordered by physicians when children and adolescents are suspected of having a rheumatic cause for their MSK pain, despite the fact that the diagnostic performance and utility of these tests and the proper interpretation of the results for pediatric populations are largely uncertain.