Choosing Wisely: 5 things doctors & patients should question about tests or treatment for rheumatologic diseases

Dr KK Aggarwal

The American Academy of Pediatrics (AAP) - Section on Rheumatology, as part of the national “Choosing Wisely” campaign, has released a list of tests and procedures commonly used to treat rheumatologic diseases that should be questioned by patients and physicians to ensure they are evidence-based and necessary.

The five list items are

1.     Do not prescribe opioids for chronic pain management in patients with autoimmune disease.

2.     Antinuclear antibody (ANA) and other autoantibody testing should not be ordered on a child unless there is strong suspicion or specific signs of autoimmune disease.

3.     Do not test for Lyme disease as a cause of musculoskeletal symptoms without an exposure history or appropriate exam findings.

4.     Do not send periodic fever syndrome genetic panels prior to infectious and oncologic workup or in a patient without clear evidence of recurrent fever.

5.     Do not order rheumatoid factor alone, or as part of a "panel" or "cascade" in children to evaluate for rheumatologic disease such as juvenile idiopathic arthritis due to musculoskeletal complaints. Do not let laboratory results guide referral.

(Source: American Academy of Pediatrics)

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA