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World J Methodol. Mar 26, 2017; 7(1): 1-8
Published online Mar 26, 2017. doi: 10.5662/wjm.v7.i1.1
Laboratory evaluation in rheumatic diseases
Murat Birtane, Selçuk Yavuz, Nurettin Taştekin
Murat Birtane, Selçuk Yavuz, Nurettin Taştekin, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Trakya University, Edirne 22040, Turkey
Author contributions: All authors equally contributed to this paper with literature review, drafting, critical revision, editing, and final approval of the final version.
Conflict-of-interest statement: All authors declare no potential conflicts of interests for this paper and no financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Selçuk Yavuz, MD, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Trakya University, Balkan Campus, Edirne 22040, Turkey. selcukyavuz@trakya.edu.tr
Telephone: +90-505-4876184 Fax: +90-284-2357641
Received: August 26, 2016
Peer-review started: August 26, 2016
First decision: November 29, 2016
Revised: January 6, 2017
Accepted: January 16, 2017
Article in press: January 18, 2017
Published online: March 26, 2017
Abstract

Autoantibodies can help clinicians to allow early detection of autoimmune diseases and their clinical manifestations, to determine effective monitoring of prognosis and the treatment response. From this point, they have a high impact in rheumatic disease management. When used carefully they allow rapid diagnosis and appropriate treatment. However, as they may be present in healthy population they may cause confusion for interpreting the situation. False positive test results may lead to wrong treatment and unnecessary anxiety for patients. Autoantibody positivity alone does not make a diagnosis. Similarly, the absence of autoantibodies alone does not exclude diagnosis. The success of the test is closely related to sensitivity, specificity and likelihood ratios. So, interpretation of these is very important for a proper laboratory evaluation. In conclusion, in spite of the remarkable advances in science and technology, a deeply investigated anamnesis and comprehensive physical examination still continue to be the best diagnostic method. The most correct approach is that clinicians apply laboratory tests to confirm or exclude preliminary diagnosis based on anamnesis and physical examination. This review will discuss these issues.

Keywords: Autoantibodies, Rheumatic diseases, Auto-immune diseases, Laboratory biomarkers, Diagnostic markers

Core tip: Serological and proteomic biomarkers are useful in confirming clinically suspected preliminary diagnosis, monitoring the treatment response and prognosis of autoimmune diseases. Tests for acute phase proteins, rheumatoid factor, anti-citrullinated peptide antibodies and antinuclear antibodies, may support the diagnoses of rheumatic diseases. But these biomarkers should be used beside a careful anamnesis and detailed physical examination. Improper using of these tests may cause false-positive results and unnecessary harmful treatments. The sensitivity, specificity and likelihood ratios of the test must be known. If the test is highly specific, the diagnosis can be confirmed in case of positivity and if it is highly sensitive, the possible diagnosis can be excluded in case of negativity.