Re-evaluation of the Anti-streptolysin O Test for Systemic Rheumatic Diseases

Kyoung Soo Shin; La-He Jearn; Think-You Kim

doi:10.3343/lmo.2011.1.3.5

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Shin, Jearn, and Kim: Re-evaluation of the Anti-streptolysin O Test for Systemic Rheumatic Diseases

Original Article

Diagnostic Hematology

Laboratory Medicine Online

Laboratory Medicine Online 2011; 1(3): 153-157.

Published online: 5 July 2011

DOI: https://doi.org/10.3343/lmo.2011.1.3.5

Re-evaluation of the Anti-streptolysin O Test for Systemic Rheumatic Diseases

Kyoung Soo Shin, M.D., La-He Jearn, M.D., Think-You Kim, M.D.

Department of Laboratory Medicine, College of Medicine, Hanyang University, Seoul, Korea.

Corresponding author: Think-You Kim, M.D. Department of Laboratory Medicine, College of Medicine, Hanyang University, 17 Haengdang-dong, Seongdong-gu, Seoul 133-792, Korea. TEL: +82-2-2290-8975, FAX: +82-2-2298-1735, tykim@hanyang.ac.kr

Received 1 February 2011 Revised 13 March 2011 Accepted 23 March 2011

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Anti-streptolysin O (ASO) test is usually used to diagnose group A streptococcal infection-related diseases, such as rheumatic fever, reactive arthritis, and various infectious diseases. Despite the recent declining incidence of these diseases, ASO test is still frequently performed as a screening test to diagnose rheumatic diseases. This study re-evaluated the clinical usefulness of ASO test in systemic rheumatic diseases (SRD).

Methods

ASO tests was performed in 825 patients between April and October in 2010. ASO levels were compared between SRD and non-SRD groups of patients. The results of ASO, C-reactive protein (CRP), and rheumatoid factor (RF) were compared among 6 subgroups of SRD: rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis, Behçet disease, Sjögren's syndrome and others.

Results

Positive results in ASO test (>200 IU/mL) were observed in 15.3% (126/825) of the patients tested. None of the ASO positive patients was, however, diagnosed with rheumatic fever or reactive arthritis. There were no statistically significant differences in the mean value (P=0.688) or positive rate (P=0.835) of ASO test between SRD and non-SRD groups. Positive rates of ASO test were also not statistically significant different among six subgroups of SRD patients (all P>0.05), whereas those of CRP and RF tests were significantly different.

Conclusions

The usefulness of ASO test is very low for diagnosing SRD, although it is frequently carried out as a screening test. We suggest that ASO test must be performed selectively when diseases from group A streptococcal infection are suspected.

Keywords: Anti-streptolysin O, Group A streptococcal infections, Systemic rheumatic disease

Figures and Tables

Fig. 1

Changes of ASO levels for 24 months in patients with systemic rheumatic diseases showing positive result at first visit.

Abbreviations: See Table 2.

Table 1

Comparison of ASO test in patients with systemic rheumatic diseases and non-systemic rheumatic diseases

^*P value by two sample t-test; ^†P value by chi-square test.

Abbreviations: ASO, anti-streptolysin O; SRD, systemic rheumatic disease.

Table 2

Comparison of ASO test among six subgroups of systemic rheumatic diseases

^*P values by chi-square test; ^†P values by Fisher's exact test.

Abbreviations: ASO, anti-streptolysin O; RA, rheumatoid arthritis; SLE, systemic lupus erythematosus; AS, ankylosing spondylitis; BD, Behçet disease; SS, Sjögren's syndrome.

Table 3

P values in six subgroups of systemic rheumatic diseases for ASO, CRP, and RF test

^*P values by chi-square test; ^†P values by Fisher's exact test.

Abbreviations: CRP, C-reactive protein; RF, rheumatoid factor; others, See Table 2.

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