Choosing Wisely:

Don’t order autoantibody panels unless positive antinuclear antibodies (ANA) and evidence of rheumatic disease.

Rationale and Comments: Up to 50% of children develop musculoskeletal pain. There is no evidence that autoantibody panel testing in the absence of history or physical exam evidence of a rheumatologic disease enhances the diagnosis of children with isolated musculoskeletal pain. Autoantibody panels are expensive; evidence has demonstrated cost reduction by limiting autoantibody panel testing. Thus, autoantibody panels should be ordered following confirmed ANA positivity or clinical suspicion that a rheumatologic disease is present in the child.
Sponsoring Organizations:
  • American College of Rheumatology—Pediatric Rheumatology
  • Sources:
  • Agency for Healthcare Research and Quality
  • Disciplines:
  • Rheumatologic
  • References: • Wong KO, Bond K, Homik J, Ellsworth JE, Karkhaneh M, Ha C, Dryden DM. Antinuclear antibody, rheumatoid factor, and cyclic-citrullinated peptide tests for evaluating musculoskeletal complaints in children. Comparative Effectiveness Review No. 50. AHRQ Publication No. 12-EHC015-EF. Rockville, Md.: Agency for Healthcare Research and Quality. March 2012.
    • Cabral DA, Petty RE, Fung M, Malleson PN. Persistent antinuclear antibodies in children without identifiable inflammatory rheumatic or autoimmune disease. Pediatrics. 1992;89:441-4.
    • Deane PM, Liard G, Siegel DM, Baum J. The outcome of children referred to a pediatric rheumatology clinic with a positive antinuclear antibody test but without an autoimmune disease. Pediatrics. 1995;95:892-5.
    • McGhee JL, Burks FN, Sheckels JL, Jarvis JN. Identifying children with chronic arthritis based on chief complaints: absence of predictive value for musculoskeletal pain as an indicator of rheumatic disease in children. Pediatrics. 2002;110:354-9.
    • Man A, Shojania K, Phoon C, Pal J, Hudoba de Badyn M, Pi D, Lacaille D. An evaluation of autoimmune antibody testing patterns in a Canadian health region and an evaluation of a laboratory algorithm aimed at reducing unnecessary testing. Clin Rheumatol. 2012; doi:10.1007/s10067-012-2141-y.

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