PMID- 32522598 OWN - NLM STAT- MEDLINE DCOM- 20210625 LR - 20220531 IS - 1778-7254 (Electronic) IS - 1297-319X (Linking) VI - 87 IP - 6 DP - 2020 Dec TI - Appropriateness of laboratory tests in the diagnosis of inflammatory rheumatic diseases among patients newly referred to rheumatologists. PG - 588-595 LID - S1297-319X(20)30103-2 [pii] LID - 10.1016/j.jbspin.2020.05.007 [doi] AB - INTRODUCTION: Autoantibody tests are commonly ordered when screening for rheumatic diseases. Rheumatoid factor (RF) and antinuclear antibody (ANA) have low positive predictive values in general practice. Overuse of diagnostic tests can result in an increase in unnecessary referrals, patient anxiety, and further costs. OBJECTIVE: The objective was to evaluate the utilization patterns, appropriateness, and associated costs of tests including ANA, extractable nuclear antibodies (ENA), anti-double stranded DNA (anti-dsDNA), RF, and HLA-B27 in patients referred to rheumatologists. METHODS: A review was conducted of consecutive referrals (accepted and rejected) using university rheumatologists' practices over one year. Inappropriate investigations, and associated costs were analyzed. Tests were considered appropriate if at least one criterion for a specific disease was provided. RESULTS: Of 638 referrals the most common reported reasons for referral were: spondyloarthropathies (SpA), rheumatoid arthritis (RA), and lupus (SLE). Prior to referral: 61% had undergone ANA testing at least once, ANA was repeated in one third; 19% had ENA and 21% had anti-dsDNA. 20% had ANA testing with no clinical indication. Half of ENA and anti-dsDNA testing was in the context of a negative ANA. RF was requested in 65% and in close to one third, there was no clinical suspicion of inflammatory arthritis. CONCLUSION: Despite the recommendations by CRA Choosing Wisely Campaign, at least 50% of laboratory investigations, including RF, ANA, ENA, and anti-dsDNA, are inappropriately ordered. More selective ordering of the above tests would lead to marked cost reduction. CI - Copyright (c) 2020 Societe francaise de rhumatologie. Published by Elsevier Masson SAS. All rights reserved. FAU - Ahrari, Azin AU - Ahrari A AD - Department of Medicine, Western University, London, ON, Canada. FAU - Barrett, Sierra S AU - Barrett SS AD - Department of Medicine, Western University, London, ON, Canada. FAU - Basharat, Pari AU - Basharat P AD - Department of Medicine, Western University, London, ON, Canada; Division or Rheumatology, Saint Joseph's Health Care, London, ON, Canada. FAU - Rohekar, Sherry AU - Rohekar S AD - Department of Medicine, Western University, London, ON, Canada; Division or Rheumatology, Saint Joseph's Health Care, London, ON, Canada. FAU - Pope, Janet E AU - Pope JE AD - Department of Medicine, Western University, London, ON, Canada; Division or Rheumatology, Saint Joseph's Health Care, London, ON, Canada. Electronic address: janet.pope@sjhc.london.on.ca. LA - eng PT - Journal Article DEP - 20200606 PL - France TA - Joint Bone Spine JT - Joint bone spine JID - 100938016 RN - 0 (Antibodies, Antinuclear) SB - IM MH - Antibodies, Antinuclear MH - Clinical Laboratory Techniques MH - Humans MH - Referral and Consultation MH - *Rheumatic Diseases/diagnosis MH - *Rheumatologists OTO - NOTNLM OT - ACPA OT - ANA OT - Choosing wisely OT - Cost OT - Quality indicators OT - RF OT - Referrals OT - Rheumatoid arthritis OT - Screening tests OT - SpA EDAT- 2020/06/12 06:00 MHDA- 2021/06/29 06:00 CRDT- 2020/06/12 06:00 PHST- 2020/02/04 00:00 [received] PHST- 2020/05/14 00:00 [accepted] PHST- 2020/06/12 06:00 [pubmed] PHST- 2021/06/29 06:00 [medline] PHST- 2020/06/12 06:00 [entrez] AID - S1297-319X(20)30103-2 [pii] AID - 10.1016/j.jbspin.2020.05.007 [doi] PST - ppublish SO - Joint Bone Spine. 2020 Dec;87(6):588-595. doi: 10.1016/j.jbspin.2020.05.007. Epub 2020 Jun 6.