Laboratory tests in the diagnosis and follow-up of pediatric rheumatic diseases: An update
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.Methods- 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
Results- 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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