American College of Rheumatology: Five Things Physicians and Patients Should Question

The ACR's Choosing Wisely Top 5 list, developed via Delphi process, literature review, member survey, and ACR Board approval. Its first recommendation is not to test ANA subserologies without a positive ANA and clinical suspicion of immune-mediated disease. Candidate notes: Do not test ANA subserologies (anti-dsDNA, Smith, RNP, SSA, SSB, Scl-70, centromere) without a positive ANA and clinical suspicion of immune-mediated disease Exceptions: anti-Jo-1 can be positive in some forms of myositis, or occasionally anti-SSA in lupus or Sjogren's syndrome, despite a negative ANA Broad autoantibody testing should be avoided; the choice of autoantibodies should be guided by the specific disease under consideration Limits noted in the record: Consensus-based (Delphi, member survey, task-force judgment) rather than derived from randomized evidence; the list itself names exceptions Items are informational and not a substitute for clinical judgment A positive ANA is not a diagnosis. Claims in this record are not verified.

A positive ANA is not a diagnosis. Claims in this record are not verified.

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