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Choosing Wisely: When to Question Tests, Procedures or Treatment for Rheumatologic Diseases


The American Academy of Pediatrics (AAP), as part of the national Choosing Wisely® campaign, today 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.

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

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

  • 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.

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

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

  • 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.

"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.

For more information, go to the Choosing Wisely list here:

Choosing Wisely® is an initiative of the ABIM Foundation, which seeks to promote conversations between clinicians and patients in choosing care that is supported by evidence; does not duplicate other tests or procedures already received; is free from harm; and truly necessary. At least 80 medical specialty societies have published more than 500 recommendations of overused tests and treatments as a result of the initiative, launched in 2012.


The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit and follow us on Twitter @AmerAcadPeds