Autoantibodies and specific serum proteins in the diagnosis of rheumatological disorders.

Abstract

Rheumatic diseases are a major cause of morbidity and long-term disability. Approximately one-third of individuals aged over 75 years of age in the UK population has significant musculoskeletal problems.' There has been a tremendous expansion in the use of laboratory services over the past 10 years in rheumatology, and present day rheumatological practice relies heavily on serological testing. This has resulted from major advances in research in this field, particularly in the areas of immunology, the genetics of the human leucocyte antigen (HLA) system and the biochemistry of inflammation. The laboratory costs involved in providing a service for rheumatology for an average district general hospital lie between £50000 and £100000 per annum (personal communication), and many biochemistry laboratories currently perform a range of serological tests. However, the clinical significance and limitations of many of these tests may not be fully understood and appreciated by both clinical and laboratory personnel. As a result, a barrage of investigations are often requested, many of which may be unnecessary and incorrectly interpreted. The utilization of laboratory services in this way is probably not cost-effective or optimal for patient care. This review covers the use and interpretation of laboratory investigations employed in the common rheumatic diseases and highlights recent developments. The methodological aspects have been discussed in detail in a recent review.'