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In a recent review, Mourad and colleagues¹ purport to provide an "evidenced-based" approach to fever of unknown origin. However, in a table entitled "Minimal Diagnostic Workup to Qualify as Fever of Unknown Origin," the authors include antinuclear antibodies (ANA) and rheumatoid factor. This is certainly not "evidenced based" and is unfortunate in that it is most likely to yield erroneous diagnoses and unnecessary workup. Recently, systematic analyses of the medical literature were performed in an effort to define the optimal use of the ANA and related tests.^2-3 When used for the diagnosis of systemic lupus erythematosus (SLE), the generic ANA has a positive likelihood ratio of approximately 2.2 and a negative likelihood ratio of approximately 0.1.³ While virtually all patients with SLE are positive for ANA, this test may also have positive results in many other autoimmune conditions and also among healthy persons (eg, 5%-6% at a titer of 1:160 . . . [Full Text of this Article]

Arthur F. Kavanaugh, MD
La Jolla, Calif

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A Comprehensive Evidence-Based Approach to Fever of Unknown Origin
Ophyr Mourad, Valerie Palda, and Allan S. Detsky
Arch Intern Med. 2003;163(5):545-551.
ABSTRACT | FULL TEXT