%0 Journal Article
%T Commentary ¨C ordering lab tests for suspected rheumatic disease
%A James N Jarvis
%J Pediatric Rheumatology
%D 2008
%I BioMed Central
%R 10.1186/1546-0096-6-19
%X You've probably heard this dozens of times before, "This might be a collagen vascular disease. Order an ANA and a rheumatoid factor." It's common on adult wards, but it's used with disturbing frequency on pediatric wards as well. One of the least appreciated advances in pediatric rheumatology over the past 20 years has been the realization that models used to evaluate adults with musculoskeletal complaints do not serve children well [1]. Thus, it is perhaps no surprise that children with even the most common form of juvenile idiopathic arthritis (JIA- the currently accepted designation for the forms of chronic arthritis that include what was previously termed juvenile rheumatoid arthritis, JRA) are routinely referred to other specialists before they see a pediatric rheumatologist [2], at the same time that pediatric rheumatology services are overwhelmed by referrals of children who do not have rheumatic disease [3,4]. This pattern of referral almost assuredly reflects, in part, the fact that joint pain is the most common reason for referrals to pediatric rheumatology clinics and the belief (based on adult models) that joint pain is a symptom of chronic arthritis in children. Work by McGhee and colleagues has shown unequivocally, however, that it is not [5]. In that same study, McGhee and colleagues reported that the second most common reason for referral for pediatric rheumatology consultation was "abnormal laboratory tests," most commonly ANA or rheumatoid factor assays. However, a growing body of evidence accumulated over more than twenty years has shown that these tests have limited or no utility in the primary care settings where they are most commonly used.This short report will summarize some of the evidence base that supports a more limited use of ANA and rheumatoid factor tests by primary care physicians evaluating children for musculoskeletal complaints and/or suspected rheumatic disease. It is intended as a review for primary care physicians who wish to be
%U http://www.ped-rheum.com/content/6/1/19