New Choosing Wisely List Tackles Opioid Prescribing, Lyme Testing

By the Editors

The American Academy of Pediatrics has issued a list of five practices in rheumatology that clinicians should avoid as part of the Choosing Wisely campaign. Here are the recommendations:

• Don't prescribe opioids to treat chronic pain in children with autoimmune conditions.

• Don't send for antinuclear antibody testing or other autoantibody tests for a child unless there are specific signs of autoimmune disease or it is strongly suspected.

• Don't test for Lyme disease in the assessment of musculoskeletal symptoms unless there is an exposure history or the child has appropriate exam findings (e.g., brief bouts of arthralgia).

• Don't order periodic fever syndrome genetic panels before infectious and oncologic workups, or for patients who lack clear evidence of recurrent fever.

• Don't order rheumatoid factor testing to evaluate children for rheumatologic diseases like juvenile idiopathic arthritis.