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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.

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