INFO - Clinical utility of common serum rheumatologic tests

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American Family Physician

15 Mar 2002

Clinical Utility of Common Serum Rheumatologic Tests

STEPHEN K. LANE, M.D., and JOSEPH W. GRAVEL, JR., M.D.

Tufts University Family Practice Residency, Malden, Massachusetts

Serum rheumatologic tests are generally most useful for confirming a

clinically suspected diagnosis. Testing for rheumatoid factor is

appropriate when rheumatoid arthritis, Sjögren's syndrome or

cryoglobulinemia is suspected. Antinuclear antibody testing is highly

sensitive for systemic lupus erythematosus and drug-induced lupus.

Anti­double-stranded DNA antibodies correlate with lupus nephritis;

the titer often corresponds with disease activity in systemic lupus

erythematosus. Testing for anti-Ro (anti-SS-A) or anti-La (anti-SS-

may help confirm the diagnosis of Sjögren's syndrome or systemic lupus

erythematosus; these antibodies are associated with the extraglandular

manifestations of Sjögren's syndrome. Cytoplasmic antineutrophil

cytoplasmic antibody testing is highly sensitive and specific for

Wegener's granulomatosis. Human leukocyte antigen-B27 is frequently

present in ankylosing spondylitis and Reiter's syndrome, but the

background presence of this antibody in white populations limits the

value of testing. An elevated erythrocyte sedimentation rate (ESR) is

a diagnostic criterion for polymyalgia rheumatica and temporal

arteritis; however, specificity is quite low. ESR values tend to

correlate with disease activity in rheumatoid arthritis and may be

useful for monitoring therapeutic response. (Am Fam Physician

2002;65:1073-80. Copyright© 2002 American Academy of Family

Physicians.)

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http://www.aafp.org/afp/20020315/1073.html

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