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New Choosing Wisely list: pediatric rheumatology :

August 12, 2019

The AAP Section on Rheumatology developed a new list for the National Choosing Wisely Program.

The evidence-based resource provides five situations in which pediatricians and patients should pause and discuss whether the medical tests, treatments and procedures are necessary. According to the list, decisions should be based on evidence, not duplicative of other tests or procedures already received, free from harm and truly necessary.

The five 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 rheumatologic disease such as juvenile idiopathic arthritis due to musculoskeletal complaints. Do not let laboratory results guide referral.

Each item also includes rationale and references. Access the list at

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