D. Mansour Nizam Al-Din: Jeddah:-
Rheumatologist and osteoporosis doctor Dr. Dhia Hussein confirmed that the great development in laboratory techniques has contributed to improving the accuracy of diagnosis, but some doctors have become overly reliant on test results without an integrated clinical assessment of the patient’s condition, which may lead to errors in diagnosis and treatment. He indicated that among the cases he encounters in his clinic are patients who have been diagnosed with “rheumatoid” disease based on a positive RF rheumatoid factor test or lupus erythematosus based on a positive ANA antibody test. Only, without clinical symptoms to support this diagnosis, and some of them were discontinued from medication after ensuring that they were free of any signs of the disease, especially since inflammatory tests such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were completely normal.
He pointed out that the rheumatoid factor test may be positive in about 5 to 10% of healthy elderly people, and it may also appear positive in other diseases such as some viral infections or non-rheumatic rheumatic diseases. Also, a negative test for rheumatoid or antibodies does not necessarily mean the absence of the disease, as between 25 and 40% of rheumatoid patients have clear symptoms such as joint swelling, pain, and morning stiffness, even though their test results are negative. As for… For ANA antibodies, they are positive in several immune diseases other than lupus erythematosus and in (5-15)% of normal people who do not suffer from any symptoms. Therefore, some other tests were performed for these patients (who were diagnosed with lupus based on the positivity of this test and were given medications), such as anti-double-stranded anti-dsDNA, and they were found to be negative, meaning that the diagnosis was wrong, citing cases of tears of joy from several girls after they discovered that they did not have lupus and the medications stopped them. Gradually, their response to treatment after clinical diagnosis is very good.
He added that modern medicine is based on the integrated diagnostic approach, which combines laboratory tests, radiological examinations, and clinical examination, so that each tool complements the other to reach an accurate diagnosis, stressing that analysis alone cannot reflect the complete picture of the disease, as laboratory analysis is an auxiliary tool and not a conclusive guide to diagnosis, calling on doctors not to rely completely on laboratory numbers and neglect the clinical examination.
Dr. Diaa concluded his statement by emphasizing that medicine, in its essence, treats the person and not the analysis paper, and that medical wisdom requires combining science, analysis, and clinical understanding of the patient’s condition. Medicine is a humanitarian message before it is an accurate science, and that the successful doctor is the one who combines knowledge, experience, and listening to the patient, because the correct understanding of the condition is the first step to successful treatment.
