The AAP Section on Rheumatology developed a new list for the National Choosing Wisely
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:
Do not prescribe opioids for chronic pain management in patients with autoimmune disease.
Antinuclear antibody 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.