A pragmatic approach to cost-effective use of laboratory tests and imaging procedures in patients with musculoskeletal symptoms.

In this article, serologic tests and other procedures widely used to establish diagnoses of patients with rheumatic diseases are discussed. Musculoskeletal conditions are among the most common seen by physicians, and the current practice of including extensive laboratory tests and imaging procedures is not only ineffective but frequently results in misdiagnosis and inappropriate treatment. The approach outlined should provide treatment that is not only cost-effective but is directed to relief of symptoms and preservation of function, which are the primary goals of the patient and physician in the management of musculoskeletal problems. The costs in diagnosis of most patients with musculoskeletal pain often are considerably greater than the costs of treatment, which might be a reasonable consideration if expensive diagnostic studies would provide meaningful specificity regarding treatment. Many results, however, are misleading, for example, phenomena seen in at least 1% of the population, such as elevated ESR, rheumatoid factor titer, ANA, elevated uric acid, and Lyme Borreliosis titer, may be seen in individuals whose primary problem is fibromyalgia. In view of the fact that treatment is generally based on clinical observations, a considerable reduction in diagnostic studies might considerably reduce costs of patient care, without adversely affecting results and outcomes.