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The Utility of Routine Screening of Patients With Uveitis for Systemic Lupus Erythematosus or Tuberculosis: A Bayesian Analysis

The Utility of Routine Screening of Patients With Uveitis for Systemic Lupus Erythematosus or... Abstract • The indications for many laboratory tests in patients with uveitis are controversial. Bayes' theorem allows a mathematical approach to the assessment of the utility of a laboratory test based on the sensitivity of the test, the specificity of the test, and the pretest likelihood that the disease the test is intended to identify is present. We have utilized Bayes' theorem to assess the utility of routine antinuclear antibody and purified protein derivative testing in patients with uveitis. Based on published data about the sensitivity and specificity of each of these tests, as well as the prevalence of systemic lupus erythematosus and tuberculosis among patients with uveitis, we calculated that a patient with uveitis and a positive antinuclear antibody test result has less than a 1% chance of having systemic lupus erythematosus and that a patient with uveitis and a positive purified protein derivative test result has a 1% likelihood of having tuberculosis. These low probabilities mean that neither test is useful in the routine evaluation of patients with uveitis, and indiscriminate use may lead to improper diagnosis, increased costs, and, occasionally, inappropriate therapy. References 1. Rosenbaum JT. Uveitis: an internist's view . Arch Intern Med . 1989;149:1173-1176.Crossref 2. Perkins ES, Folk J. Uveitis in London and Iowa . Ophthalmologica . 1984;189:36-40.Crossref 3. Henderley DE, Genstler AJ, Smith RE, Rao NA. Changing patterns of uveitis . Am J Ophthalmol . 1987;103:131-136. 4. Griner PF, Mayewski RJ, Mushlin AI, Greenland P. Selection and interpretation of diagnostic tests and procedures: principles and applications . Ann Intern Med . 1981;94:553-600. 5. Notman DD, Kurata N, Tan EM. Profiles of antinuclear antibodies in systemic rheumatic diseases . Ann Intern Med . 1975;83:464-469.Crossref 6. Bloch KT, Salvaggio JE. Use and interpretation of diagnostic immunologic laboratory tests . JAMA . 1982;248:2734-2758.Crossref 7. Wernick R. Avoiding laboratory test misinterpretation in geriatric rheumatology . Geriatrics . 1989;44:61-80. 8. Snyderman R. Humoral immunity . In: Utsinger PD, Zvaifler PD, Ehrlich NJ, eds. Rheumatoid Arthritis . Philadelphia, Pa: JB Lippincott; 1985:243-249. 9. Epstein WV, Tan M, Easterbrook M. Serum antibody to double-stranded RNA and DNA in patients with idiopathic and secondary uveitis . N Engl J Med . 1971;285:1502-1506.Crossref 10. Rahi AHS, Holborow EJ, Perkins ES, Gungen YY, Dinning WJ. Immunological investigations in uveitis . Trans Ophthalmol Soc U K . 1976;96:113-122. 11. Kijlstra A, Linssen A, Ockhuizen T, et al. Diagnostic tests in uveitis . In: Saari KM, ed. Uveitis Update . Princeton, NJ: Excepta Medica; 1984:421-425. 12. Gold DH, Morris DA, Henkind P. Ocular findings in systemic lupus erythematosus . Br J Ophthalmol . 1972;56:800-804.Crossref 13. Holden M, Dubin MR, Diamond PH. Frequency of negative intermediate-strength tuberculin sensitivity in patients with active tuberculosis . N Engl J Med . 1971;285:1506-1509.Crossref 14. Nash DR, Douglass JE. Anergy in active pulmonary tuberculosis . Chest . 1980;77:32-37.Crossref 15. Abrams J, Schlaegel TF. The tuberculin skin test in the diagnosis of tuberculous uveitis . Am J Ophthalmol . 1983;96:295-298. 16. Chaparas SD, Vandiviere HM, Melvin I, et al. Tuberculin test: variability with the Mantoux procedure . Am Rev Respir Dis . 1985;132:175-177. 17. Reichman LB, O'Day R. Tuberculous infection in a large urban population . Am Rev Respir Dis . 1978;117:705-712. 18. Dutt AK, Moers D, Stead WW. Short-course chemotherapy for extrapulmonary tuberculosis . Ann Intern Med . 1986;104:7-12.Crossref 19. Rembold CM, Watson D. Posttest probability calculation by weights: a simple form of Bayes' theorem . Ann Intern Med . 1988;108:115-120.Crossref 20. Sackett DL, Haynes RB, Taylor DW. Compliance . In: Inman WHW, ed. Monitoring for Drug Safety . Philadelphia, Pa: JB Lippincott; 1980:427-438. 21. Tan EM, Cohen AS, Fries JF. The 1982 revised criteria for the classification of systemic lupus erythematosus . Arthritis Rheum . 1982;25:1271-1277.Crossref 22. Rosenbaum JT. Uveitis . In: McCarty DJ, ed. Arthritis and Allied Conditions: A Textbook of Rheumatology . Philadelphia, Pa: Lea & Febiger; 1989:1563-1568. 23. Rosenbaum JT, Bennett RM. Chronic anterior and posterior uveitis and primary Sjögren's syndrome . Am J Ophthalmol . 1987;104:346-352. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Ophthalmology American Medical Association

The Utility of Routine Screening of Patients With Uveitis for Systemic Lupus Erythematosus or Tuberculosis: A Bayesian Analysis

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Publisher
American Medical Association
Copyright
Copyright © 1990 American Medical Association. All Rights Reserved.
ISSN
0003-9950
eISSN
1538-3687
DOI
10.1001/archopht.1990.01070110107034
Publisher site
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Abstract

Abstract • The indications for many laboratory tests in patients with uveitis are controversial. Bayes' theorem allows a mathematical approach to the assessment of the utility of a laboratory test based on the sensitivity of the test, the specificity of the test, and the pretest likelihood that the disease the test is intended to identify is present. We have utilized Bayes' theorem to assess the utility of routine antinuclear antibody and purified protein derivative testing in patients with uveitis. Based on published data about the sensitivity and specificity of each of these tests, as well as the prevalence of systemic lupus erythematosus and tuberculosis among patients with uveitis, we calculated that a patient with uveitis and a positive antinuclear antibody test result has less than a 1% chance of having systemic lupus erythematosus and that a patient with uveitis and a positive purified protein derivative test result has a 1% likelihood of having tuberculosis. These low probabilities mean that neither test is useful in the routine evaluation of patients with uveitis, and indiscriminate use may lead to improper diagnosis, increased costs, and, occasionally, inappropriate therapy. References 1. Rosenbaum JT. Uveitis: an internist's view . Arch Intern Med . 1989;149:1173-1176.Crossref 2. Perkins ES, Folk J. Uveitis in London and Iowa . Ophthalmologica . 1984;189:36-40.Crossref 3. Henderley DE, Genstler AJ, Smith RE, Rao NA. Changing patterns of uveitis . Am J Ophthalmol . 1987;103:131-136. 4. Griner PF, Mayewski RJ, Mushlin AI, Greenland P. Selection and interpretation of diagnostic tests and procedures: principles and applications . Ann Intern Med . 1981;94:553-600. 5. Notman DD, Kurata N, Tan EM. Profiles of antinuclear antibodies in systemic rheumatic diseases . Ann Intern Med . 1975;83:464-469.Crossref 6. Bloch KT, Salvaggio JE. Use and interpretation of diagnostic immunologic laboratory tests . JAMA . 1982;248:2734-2758.Crossref 7. Wernick R. Avoiding laboratory test misinterpretation in geriatric rheumatology . Geriatrics . 1989;44:61-80. 8. Snyderman R. Humoral immunity . In: Utsinger PD, Zvaifler PD, Ehrlich NJ, eds. Rheumatoid Arthritis . Philadelphia, Pa: JB Lippincott; 1985:243-249. 9. Epstein WV, Tan M, Easterbrook M. Serum antibody to double-stranded RNA and DNA in patients with idiopathic and secondary uveitis . N Engl J Med . 1971;285:1502-1506.Crossref 10. Rahi AHS, Holborow EJ, Perkins ES, Gungen YY, Dinning WJ. Immunological investigations in uveitis . Trans Ophthalmol Soc U K . 1976;96:113-122. 11. Kijlstra A, Linssen A, Ockhuizen T, et al. Diagnostic tests in uveitis . In: Saari KM, ed. Uveitis Update . Princeton, NJ: Excepta Medica; 1984:421-425. 12. Gold DH, Morris DA, Henkind P. Ocular findings in systemic lupus erythematosus . Br J Ophthalmol . 1972;56:800-804.Crossref 13. Holden M, Dubin MR, Diamond PH. Frequency of negative intermediate-strength tuberculin sensitivity in patients with active tuberculosis . N Engl J Med . 1971;285:1506-1509.Crossref 14. Nash DR, Douglass JE. Anergy in active pulmonary tuberculosis . Chest . 1980;77:32-37.Crossref 15. Abrams J, Schlaegel TF. The tuberculin skin test in the diagnosis of tuberculous uveitis . Am J Ophthalmol . 1983;96:295-298. 16. Chaparas SD, Vandiviere HM, Melvin I, et al. Tuberculin test: variability with the Mantoux procedure . Am Rev Respir Dis . 1985;132:175-177. 17. Reichman LB, O'Day R. Tuberculous infection in a large urban population . Am Rev Respir Dis . 1978;117:705-712. 18. Dutt AK, Moers D, Stead WW. Short-course chemotherapy for extrapulmonary tuberculosis . Ann Intern Med . 1986;104:7-12.Crossref 19. Rembold CM, Watson D. Posttest probability calculation by weights: a simple form of Bayes' theorem . Ann Intern Med . 1988;108:115-120.Crossref 20. Sackett DL, Haynes RB, Taylor DW. Compliance . In: Inman WHW, ed. Monitoring for Drug Safety . Philadelphia, Pa: JB Lippincott; 1980:427-438. 21. Tan EM, Cohen AS, Fries JF. The 1982 revised criteria for the classification of systemic lupus erythematosus . Arthritis Rheum . 1982;25:1271-1277.Crossref 22. Rosenbaum JT. Uveitis . In: McCarty DJ, ed. Arthritis and Allied Conditions: A Textbook of Rheumatology . Philadelphia, Pa: Lea & Febiger; 1989:1563-1568. 23. Rosenbaum JT, Bennett RM. Chronic anterior and posterior uveitis and primary Sjögren's syndrome . Am J Ophthalmol . 1987;104:346-352.

Journal

Archives of Ophthalmology – American Medical Association

Published: Sep 1, 1990

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