Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
FEAR (False ELISA Associated Rheumatic) Syndrome in Children.
Goldsmith1, Donald P., Martucci3, Carolann, Lvovich2, Svetlana
St Christopher Hosp Children/Drexel University College of Medicine, Philadelphia, PA
St Christopher's Hosp Children/Drexel University College of Medicine, Philadelphia, PA
St Christopher's Hospital for Children, Philadelphia, PA
Non specific arthralgias associated with a positive ANA remain a common referral source to the pediatric rheumatologist. Multiple studies have documented the unlikely progression to a recognizable inflammatory disorder and allow the pediatric rheumatologist to effectively alleviate parent and patient anxiety. There is now increased use of ANA reflex panels which use solid phase ELISA assays rather than indirect immunofluorescence. If positive, even without a reported quantitative titer, these panels automatically cascade (with increased cost) to additional antibody tests. Children are now being referred for isolated positive ELISA tests such as anti centromere, anti SS-A/B, anti SCL-70, anti Sm/RNP, and anti dsDNA antibodies.
To characterize and bring to attention increasing numbers of children with a positive ANA screen without a quantitative titer and one or more positive additional specific antibody tests.
A retrospective outpatient chart review from 06/01/2008 to 01/01/2010)
Of 415 new patient assessments seen over this 18 month period we identified 20 (5%) children with a positive ANA screen and one or more additional positive antibody tests. All children had non specific complaints, primarily arthralgias, myalgias, and/or transient cutaneous eruption. These tests had been obtained prior to consultative assessment. There were 19 F, 1M; 16 White, 3 African-American, and 1 Hispanic. Mean age 11.4 y (range 617). Within this group of children there were 6 positive tests for anti SS-A, 4 anti SS-B, 4 anti SCL-70, 3 anti centromere, 3 anti RNP, 2 anti Smith, and 2 anti dsDNA. Four children had more than 1 antibody present. The average duration of symptoms prior to laboratory assessment was 18 months (range 448). Prior to assessment 15(75%) of the parents had seriously web researched those disorders associated with each of these antibodies. None of these children have thus far developed a characteristic pediatric rheumatic disorder.
Although these children require careful follow-up observation, in view of the extended duration and non specific nature of symptoms prior to the recognition of each positive antibody as well as the lack of corroborative physical findings we predict it's unlikely that significant morbidity will develop. As 5% of our recent new patient assessments/year, this represents a significant number of children. Parent/patient fear and anxiety is considerable and in our opinion lead to subtle variants of the vulnerable child syndrome. To minimize the creation of FEAR syndrome we need to better inform our referring physician base about the most suitable, if any, ANA tests to order. Commercial laboratories should fully disclose the nature of each panel and not solely offer cascading tests on pre-printed forms.
To cite this abstract, please use the following information:
Goldsmith, Donald P., Martucci, Carolann, Lvovich, Svetlana; FEAR (False ELISA Associated Rheumatic) Syndrome in Children. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1341