ACR's Top 5 Questionable Things in Rheumatology

Update 2/22/13: Lists of questionable things in 17 different fields.

Arthritis Care & Research 2013; 65(3):329–339

Today, the ACR published published a list of 5 potentially wasteful and/or harmful things to be considered in rheumatology practice.

Rather than issuing true practice guidelines, these are meant to ask us to consider what is best for each individual patient.

Rather than being a prescriptive set of rules, the Top 5 lists are meant to leave room for clinical judgment.

We mentioned the utility of a positive ANA yesterday, and first item reminds us to also carefully consider when to order more specific autoantibodies:

1) Do not test antinuclear antibody (ANA) subserologies without a positive ANA and clinical suspicion of immune-mediated disease

Both the ANA and specific antibodies need to be ordered after applying the basics of rheumatology: a good history and exam.

The remaining items listed:

2) Do not test for Lyme disease as a cause of musculoskeletal symptoms without an exposure history and appropriate examination findings

3) Do not perform magnetic resonance imaging (MRI) of the peripheral joints to routinely monitor inflammatory arthritis

4) Do not prescribe biologic agents for RA before a trial of methotrexate (or other conventional nonbiologic DMARD)

5) Do not routinely repeat dual x-ray absorptiometry (DXA) scans more often than once every 2 years

In summary: use clinical judgement.