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Laboratory tests in the diagnosis and follow-up of pediatric rheumatic diseases: An update
Seminars in Arthritis and Rheumatism, 06/23/09

Breda L et al. – Study concludes that laboratory investigations play an important role in the diagnosis and follow-up of inflammatory rheumatic diseases in children. Routine laboratory tests are useful to confirm a suspected diagnosis, to assess disease activity, and to measure the response and toxicity to treatment.

• A review of literature to:
  • Evaluate the role of common laboratory tests and
  • Examine the recent progress in the laboratory diagnosis of pediatric rheumatic diseases
• PubMed database (1950-2008) search with relevant keywords
• All original and review articles in English were reviewed as well as textbooks of pediatric rheumatology

• Laboratory tests: ESR, CRP, blood cytology, complement system, ferritin, ASO titer play an important role in confirming a diagnosis and f/u of rheumatic diseases
  • ESR: most widely measured index of the acute phase response
  • CRP: very useful in the rapid diagnosis of infection
  • Combination of CRP and ESR may provide the most useful information
  • Complement levels (C3 and/or C4): useful in the f/u of SLE and membranoproliferative glomerulonephritis
  • Ferritin: a laboratory hallmark of primary and secondary hemophagocytic lymphohistiocytosis
  • ASO titer: confirms a diagnosis of acute rheumatic fever
  • Other important antibody markers of streptococcal infection include antihyaluronidase, antideoxyribonuclease B, and antistreptokinase antibodies
• In pediatric age, the main indication for SF analysis is suspected joint infection
• ANA, anti-Smith antigen, and anti-dsDNA Ab are important in the diagnosis of SLE
• Anti-SSA/Ro and anti-SSB/La Abs are associated with Sjögren's syndrome and congenital heart block
• Anti-U1 small nuclear ribonucleoprotein Abs show high specificity for mixed connective tissue disease
• Repetitive spontaneous abortions, thrombocytopenia, and many types of venous or arterial thrombosis are associated with antiphospholipid Abs
• Presence of cytoplasmic antineutrophil Abs is essential in the diagnosis of Wegener granulomatosis
• Underlying single causative gene defects led to the identification of several autoinflammatory diseases

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