(HealthDay News) – The top five pediatric rheumatology-related issues that physicians and patients should question have been released by the American College of Rheumatology (ACR) as part of the Choosing Wisely campaign.

Members of the ACR used a multi-stage process involving consensus methodology and literature reviews to create the list. Items with high content agreement and perceived prevalence were advanced to a survey among ACR members who specialize in pediatric rheumatology. After literature review, an ACR special committee reviewed their relevance to rheumatology, the levels of evidence, and survey results, and drafted the final list.

The top five recommendations include: (1) avoiding ordering of autoantibody panels, unless there is antinuclear antibody (ANA) positivity and evidence of rheumatic disease; (2) Lyme disease should not be tested as a cause of musculoskeletal symptoms without a history of exposure and appropriate exam findings; (3) surveillance joint radiographs should not be routinely performed for monitoring juvenile idiopathic arthritis (JIA) disease activity; (4) methotrexate toxicity labs should not be performed more often than every 12 weeks for stable doses; and (5) a confirmed positive ANA does not need repeating in patients with established JIA or systemic lupus erythematous.

“By no means should this Top 5 list replace the critical and individualized decision making that each pediatric rheumatology provider undergoes with patients and families,” Stacy P. Ardoin, MD, MHS, from The Ohio State University in Columbus, said in a statement. “This list does provide our community with an opportunity to reconsider the evidence basis for some of our routine practices and consider whether the benefits outweigh the potential costs.”

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