New Lists of Tests Rheumatologists Should Avoid


The American College of Rheumatology's new list of five procedures judged questionable as part of the "Choosing Wisely" campaign are meant for pediatric rheumatologists (but may miss their target).

The American College of Rheumatology (ACR) has issued a second list of five procedures judged questionable by an expert panel as part of the "Choosing Wisely" campaign designed by more than 50 member organiztions to help reduce unneeded medial expense.

Following on an earlier list of procedures to think twice about, released by the society WHEN?, this list focuses on pediatric rheumatology. Although the announcement calls these "tests and treatments commonly used in rheumatology," pediatric rheumatologist Jon (Sandy) Burnham MD said that many pediatric rheumatology practices would not find this a surprising set of guidelines, and that none of them reflects common procedure at the Children's Hospital of Philadelphia, where he is attending physician.

He went on to say that pediatric generalists and other pediatric specialists do order such tests routinely, and the list could provide ammunition to effect a more generally accepted change in procedures.

The ACR announcement also anticipates that the recommendations will foster discussions with patients and their parents.

The list of practices to avoid without good cause, according to ACR:

•  Ordering antibody panels when antinuclear antibodies are not positive and there is no evidence of rheumatic disease;
•  Testing for Lyme disease as a cause of musculoskeletal symptoms without an exposure history and appropriate exam findings;
•  Routine surveillance joint radiographs to monitor juvenile idiopathic arthritis JIA) disease activity;
•  Methotrexat toxicity labs more often than every 12 weeks fir JIA patients on stable doses;
•  Repeating a confirmed positive ANA in patients with established JIA or systemic lupus erythematosus.

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