ACR releases five 'Don'ts' for rheumatologists

(HealthDay)—As part of the Choosing Wisely campaign, the American College of Rheumatology (ACR) has issued a list of the top five tests and treatments commonly misordered by rheumatologists; the list has been published in the March issue of Arthritis Care & Research.

Jinoos Yazdany, M.D., from the University of California San Francisco, and colleagues utilized consensus methodology and literature reviews to develop the list. Rheumatologists from diverse practice settings, a random sample of ACR members, and a task force all contributed.

The researchers found that, of the 105 unique items proposed by rheumatologists, the list was narrowed down to 22 items during the Delphi method. A total of 1,052 rheumatologists (17 percent response rate) participated in the member-wide survey. Utilizing survey results and available scientific evidence, the five selected items that should be avoided are: (1) testing for antinuclear antibodies (ANA) without a positive ANA and clinical suspicion of immune-mediated disease; (2) testing for Lyme disease without exposure history and appropriate exam findings; (3) magnetic resonance imaging of the peripheral joints to routinely monitor inflammatory arthritis; (4) repeating scans for bone absorptiometry more than once every two years; and (5) prescribing biologic therapy for rheumatoid arthritis before trying methotrexate.

"The ACR top five list is intended to promote discussions between physicians and patients about health care practices in rheumatology whose use should be questioned and to assist rheumatologists in providing high-value care," the authors write.

Several authors report financial ties to the pharmaceutical industry.

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