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KMID : 1037820130020020066
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Journal of Pain and Autonomic Disorders
2013 Volume.2 No. 2 p.66 ~ p.71
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Diagnostic Approach and Screening Tests for Musculoskeletal Pain
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Lee Sang-Heon
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Abstract
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Diagnosing musculoskeletal complaints including arthritis is often difficult, as many symptoms are similar
among different diseases. To make an accurate diagnosis, a physician may need to conduct to review the
medical history and perform physical examination as well as appropriate diagnostic laboratory tests. Many
systemic rheumatic diseases are initially presented by musculoskeletal complaints, and caused by
autoimmune reaction. Therefore, diagnostic laboratory tests including autoantibodies and immunologic tests are very helpful for screening and confirming the diagnosis based on strong clinical suspicion. Clinical utility of diagnostic laboratory test in rheumatic diseases can be summarized as three aspects (screening, confirming, activity follow up). Highly sensitive tests can be used as screening test as in antinuclear antibody in systemic lupus erythematous (SLE) and erythrocyte sedimentation rate (ESR) in temporal arteritis. Specific tests, even though less sensitive, can be used as a confirmatory diagnostic test in SLE (anti-Sm and anti-dsDNA antibody) in proper clinical settings. Recent discovery of anti-citrullinated cyclic protein (anti-CCP) can serve as a specific diagnostic marker for early rheumatoid arthritis. Lastly, acute phase reactants including ESR and C-reactive protein can be utilized as activity measure in systemic arthritis and vasculitides. Serum complement and anti-dsDNA are also useful markers for measuring SLE disease activity. Since establishing a diagnosis of systemic rheumatic diseases presenting as musculoskeletal complaints requires an integration
of characteristic clinical findings, physical examination and the results of laboratory diagnostic tests, the clinical utility of laboratory tests should be based on high clinical suspicion and interpreted in proper clinical settings.
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KEYWORD
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Autoantibodies, Systemic rheumatic diseases, Antinuclear antibody
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