Rheumatic disease: choosing the most useful diagnostic tests

Many tests are available for evaluating older patients with suspected rheumatic disease. Factors that help you determine which tests would be most helpful are the individual history and physical exam plus your knowledge of how likely a particular disease is in that population. The clinical utility of common tests such as the ESR, rheumatoid factor, and antinuclear antibody is quite limited. Other autoantibodies may be useful in well-defined contexts. Radiographic evaluation is useful when particular problems are suspected but is rarely helpful as a diagnostic test in older patients with recent onset of symptoms and no history of trauma. In select situations, other specific diagnostic testing (eg, for bony pain, neuropathies, and vasculitides) is indicated.