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Testing for Rheumatological Diagnoses in Children.

Judith A Smith1

  • 1University of Wisconsin-Madison School of Medicine and Public Health, Department of Pediatrics.

European Paediatrics Review
|November 8, 2011
PubMed
Summary
This summary is machine-generated.

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Pediatricians should not use laboratory and radiological tests as general rheumatological screens. Ordering specific tests for juvenile idiopathic arthritis, juvenile spondyloarthritis, and lupus requires a high clinical suspicion for accurate diagnosis.

Area of Science:

  • Pediatric Rheumatology
  • Diagnostic Test Evaluation
  • Clinical Utility

Background:

  • Paediatricians frequently order laboratory and radiological tests for children with suspected rheumatological conditions before specialist referral.
  • Current testing patterns indicate a potential misunderstanding of the diagnostic value and limitations of these tests in pediatric rheumatology.
  • Common conditions include juvenile idiopathic arthritis (JIA), juvenile spondyloarthritis (JSpA), and systemic lupus erythematosus (SLE).

Purpose of the Study:

  • To review common rheumatological diagnoses in pediatric subspecialty clinics: JIA, JSpA, SLE, and related connective tissue diseases.
  • To evaluate the diagnostic utility, including sensitivity, specificity, and positive predictive value, of frequently ordered tests: anti-nuclear antibodies (ANA), rheumatoid factor (RF), human leukocyte antigen (HLA)-B27, and radiological imaging.

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  • To emphasize appropriate test selection based on clinical suspicion rather than broad screening.

    • Main Methods:

    • Review of common pediatric rheumatological conditions and associated diagnostic tests.
    • Analysis of the sensitivity, specificity, and positive predictive value of anti-nuclear antibodies (ANA), rheumatoid factor (RF), human leukocyte antigen (HLA)-B27, and radiological tests.
    • Discussion on the appropriate application of these tests in clinical practice.

    Main Results:

    • No single laboratory or radiological test is sufficiently diagnostic to be used as a general rheumatological screen in children.
    • The diagnostic utility of tests like ANA, RF, and HLA-B27 varies, and they are not standalone diagnostic tools.
    • Radiological tests have specific indications but are not appropriate for initial, undifferentiated screening.

    Conclusions:

    • Specific rheumatological tests should only be ordered when there is a strong clinical suspicion for a particular disease entity.
    • A better understanding of test diagnostic utility can reduce unnecessary testing, patient anxiety, and healthcare costs.
    • Judicious use of diagnostic tests aids in accurate interpretation and timely management of pediatric rheumatological diseases.