Background:

The diagnosis of rheumatologic diseases is based on clinical data, blood and imaging investigations, and in some cases even on histopathology. Blood tests are important in confirming clinically suspected diagnosis and monitoring the disease activity. The interpretation of laboratory tests should be done as adjuncts to a careful review of history and physical examination.

The value and usefulness of a test in evaluation a certain condition depends on its pretest probability. A positive test result with high pretest probability helps to confirm a diagnosis, but a negative test result with low pretest probability helps to rule out the diagnosis.

Our objective is to evaluate the laboratory diagnosis of rheumatic diseases.

Methods:
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A literature search was conducted through MEDLINE and valid journals for articles published.

Results:
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ESR and CRP are two important markers of inflammation. CRP is a more sensitive marker of inflammation and is independent of factors affecting ESR. ANA testing is very useful in establishing a diagnosis of SLE. ANA titer is not used for evaluating the disease activity of SLE. Anti-DNA antibody testing is very useful in the evaluating and monitoring of SLE.

Anti-Scl 70 antibody is very useful in evaluating systemic sclerosis and anticentromere antibody in diagnosing limited scleroderma. The sensitivity of rheumatoid factor for rheumatoid arthritis is about 50% - 80% and specificity is from 85% to 90%. Between 70% and 90% of known case of Wegener's granulomatosis ,have ANCAs positive test (c-ANCA pattern), including antibodies directed against PR3.

Also about 40% - 80% of known case of microscopic polyangiitis are ANCA positive and usually have the pANCA pattern with MPO specificity.

Conclusions:
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Clinicians cannot rely heavily on blood tests in making the diagnosis of rheumatologic diseases, except for certain tests that are highly specific for certain diseases. Improper application of these tests leads to misdiagnosis, inappropriate therapy, and unnecessary health care expenses.

Also they interpreting lab findings should bear in mind that the results can vary from laboratory to laboratory (biases), and hence serial determinations should be done by the same laboratory.

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