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[37] The result is that Americans pay two to four times more than patients in peer countries for the same drugs

However, without clinical evidence of diabetes, occult malignancy, arthritis, multiple sclerosis, or other systemic illness, serologic studies, such as rheumatoid factor, antinuclear anti- bodies, Borrelia burgdorferi, muscle enzymes, and serum complement, are generally not necessary.47 According to Hench, 32 Goldenberg, 47 and others, 10% to 15% of patients with FMS have isolated abnormal serologic test results with- out evidence of underlying connective tissue disease, which can often be misleading