Sometimes a patient will come to us in the rheumatology clinic telling us he did the rheumatism blood test and it was positive. For that reason he was diagnosed as having rheumatism and he is come to us to prescribe for him treatment for that rheumatism. Before we comment on this common scenario that we encounter in our clinics, let us first agree together on the following basic fact.
Science and pseudoscience:
In every field of knowledge in this world, there is the science and the scientific evidence and there is the pseudoscience or the myth or the misconception that has no scientific or rational basis. Unfortunately, misconceptions can be truly so powerful and so established in people's knowledge and culture. What we mean to say here is that there is nothing that is called "the rheumatism lab test" that really exists. Rheumatism is actually a term that refers to a group of painful conditions that affect the musculoskeletal system and not a specific disease or diagnosis. Diagnosis of each disease is actually based on the patient's history and examination, and not on any particular lab test.
So what does a patient usually mean when he says "the rheumatism blood test"?
There are three lab tests that are known in the common culture of patients and nonprofessionals as potential rheumatism lab tests. Each patient or group of patients chooses one of the three tests to assign it that name and to believe in it as the test that diagnoses some disease called "rheumatism". These test are the anti-streptolysin O titer (the ASOT test), the C-reactive protein test (CRP test) and the erythrocyte sedimentation rate test (ESR test). From a scientific medical perspective, any one of those three tests is not diagnostic of any medical conditions. At best, a positive test for any of the three tests will offer just a complementary piece of information that the doctor will use while formulating the big picture for a medical diagnosis. In other words, the information we get from any one of the three tests in medicine is just accessory information and not critical diagnostic information.
For example, a positive test for the ASOT test only reflects that the patient has antibodies to a certain microbe. This is considered a nonspecific finding or a minor criterion that requires several major criteria to diagnose a medical disorder called rheumatic fever. But alone, it means virtually nothing. A positive or high CRP test or a high ESR test only tell you there is some inflammation somewhere in the body but do not specify what kind of inflammation. Other data from the history and examination of the patient should help you to pinpoint the reason and the diagnosis for a positive or high result for any of those two lab tests.
Although this might sound odd to what many people know, but it is better that you know this now so you don't get into the unnecessary dilemma of doing odd lab tests for diagnosing odd medicalconditions.
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This post was prepared and published by Dr. Hatem Eleishi. Dr. Hatem Eleishi is a professor of rheumatology at Cairo university (Egypt) and is especially dedicated to supporting arthritis patients with online educational videos and articles about arthritis causes and treatment. He also runs a rheumatology clinic in Cairo and a center for online medical consultations that, in addition to providing online rheumatology consultations, also provides online medical consultations in several different medical specialties by expert consultants from Egypt, Canada and the United States.
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