Medical Professional Publications

When Should Antinuclear Antibody (ANA) or Rheumatoid Factor Tests Be Ordered for Children?

Columbus, OH — June 2017

Charles H. Spencer, MDCharles H. Spencer, MD, a senior rheumatologist at Nationwide Children’s Hospital, answers a common question from primary care providers.

Both tests are ordered more frequently than they should be for children, leading to unnecessary health care costs and worry for patients and their families. Still, there are situations when the tests are useful:

ANA   

An ANA test should be ordered when a child or adolescent is suspected to have systemic lupus erythematosus (SLE). Suspicion may occur when a patient presents with polyarthritis; certain skin conditions associated with lupus, such as malar rash or palatal ulcer; abnormal urinalysis with blood or protein present; serious neurological concerns such as seizure or psychosis; and pericarditis.

A child with juvenile idiopathic arthritis should also have ANA testing to assess for risk of uveitis and need for more frequent eye checks.

In most other situations, an ANA test is not helpful and should not be ordered as a screening test for non-specific complaints such as musculoskeletal pain. Studies have found that significant numbers of “healthy” children and adults can have positive ANA test results. The sensitivity and specificity of ANA testing for autoimmune rheumatic disease is considered very low, and children referred with a positive result (in the absence of other SLE symptoms) are rarely diagnosed with a chronic condition.

Rheumatoid Factor        

Rheumatoid factor testing is very useful for diagnosing classic rheumatoid arthritis in adults with small joint arthritis. That is not the case in children.

Only 10 percent to 15 percent of children with definite arthritis, such as juvenile idiopathic arthritis, have a positive rheumatoid factor test. A child under 10 years of age with joint pain should not have the test because the yield is so low. Yet the test should be ordered for any child with definite arthritis, especially for teenagers with small joint disease.

Many doctors order rheumatoid factor testing for children assuming it is as useful as it is for adults. It isn't. Better tests to order before referral might include complete blood count (CBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), comprehensive metabolic panel (CMP) and urinalysis.

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