Five high-priced tests and treatments routinely used in rheumatology are often unnecessary, according to the American College of Rheumatology (ACR). The list of procedures, published recently in Arthritis Care & Research, is the ACR’s contribution to the Choosing Wisely campaign, a joint venture of the American Board of Internal Medicine Foundation and Consumer Reports. More than 35 other medical specialty societies have joined the campaign, which seeks to reduce the use of services that drive up health care costs and don't benefit patients.

Debate has been raging over how to cut back on high medical expenses. Choosing Wisely is not meant to dictate what is or isn’t appropriate, but to encourage “physicians, patients and other health care stakeholders to think and talk about medical tests and procedures that may be unnecessary, and in some instances can cause harm,” according to its website.

Charles M. King II, MD, a practicing rheumatologist at North Mississippi Medical Center in Tupelo, co-chaired the ACR’s Top 5 Task Force with Jinoos Yazdany, MD, assistant professor of medicine in the division of rheumatology at the University of California, San Francisco. Both say the selection process for picking the Top 5 was rigorous and based on scientific evidence.

“The task force generated a list of more than 100 [tests and treatments] commonly ordered by rheumatologists that were expensive and/or lacked evidence of significant benefit,” Dr. King explains.

After being pared down to 22 items, the list was sent to all ACR members in the United States. The membership survey resulted in 10 items, from which the top five were selected based on the best scientific evidence.

“We were expecting that some of these issues might be thorny or lead to a lot of debate … but in fact, there was far more agreement than there was disagreement,” Dr. Yazdany says.

The following recommendations are the Top 5:

1. Don’t test antinuclear antibody (ANA) sub-serologies without a positive ANA and clinical suspicion of immune-mediated disease.

An ANA test is used to help screen for autoimmune disorders, such as lupus, Sjögren’s syndrome and juvenile arthritis. Antinuclear antibodies are seen in many medical conditions as well as in some healthy people, so a positive ANA test is often followed by a panel of tests – subsets of the original – to confirm the diagnosis. Because these tests are usually negative if the ANA test is negative, the ACR recommends against performing them in the absence of a positive ANA. Exceptions include a test called anti-Jo-1, which can be positive in some forms of myositis, and an anti-SSA test in lupus or Sjögren’s syndrome.