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When to Question Tests, Procedures or Treatment for Rheumatologic Diseases

Parents who are seeking answers for their child’s rheumatic diseases should make sure suggested procedures are necessary.  The American Academy of Pediatrics, as part of the national Choosing Wisely® campaign, recently released a list of tests and procedures commonly used to treat rheumatic diseases that should be questioned by patients and physicians to ensure they are evidence-based and necessary.  Prescribing opioids and testing for Lyme disease are among the top five items of concern listed by the AAP Section on Rheumatology. These specialists diagnose and treat autoimmune disease and conditions that affect the joints tendons, ligaments, bones and muscles, including arthritis. 

"There are many misconceptions about autoimmune conditions and musculoskeletal diseases that we work to dispel," said Grant Syverson, MD, FAAP, member of the AAP Section on Rheumatology. "Patients and physicians are encouraged to discuss any questions or concerns about tests or treatment and how they might impact health."

The five list items are:

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

2. Antinuclear antibody 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 rheumatic disease such as juvenile idiopathic arthritis due to musculoskeletal complaints. Do not let laboratory results guide referral. 

"These statements will help guide work-up and, when questions arise, open a dialogue between treating physicians and pediatric rheumatologists," said Miriah Gillispie-Taylor, MD, FAAP, member of the AAP Section on Rheumatology.

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