American College of Rheumatology – Pediatric Rheumatology

View all recommendations from this society

Released October 27, 2013

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

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.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The American College of Rheumatology (ACR) used a multi-stage process combining consensus methodology and literature reviews to arrive at its Pediatric Rheumatology Top 5 list. Items were generated by a group of practicing pediatric rheumatologists using the Delphi method. Items with high content agreement and perceived prevalence advanced to a survey of ACR members who listed pediatric rheumatology as their specialty. Based on member input related to content agreement, impact and item ranking, candidate items advanced to literature review. The ACR Special Committee on Pediatric Rheumatology discussed the items in light of their relevance to rheumatology, level of evidence to support their inclusion in the final list and the member survey results, and drafted the final pediatric rheumatology Top 5 list. The list was reviewed and approved by the ACR Board of Directors.

ACR’s disclosure and conflict of interest policy can be found at www.rheumatology.org.

ACR Special Committee on Pediatric Rheumatology

  • Polly Ferguson, MD, Chair – University of Iowa Carver College of Medicine, Iowa City, IA
  • Stacy Ardoin, MD – Ohio State University, Columbus, OH
  • Mara Becker, MD – Children’s Mercy Hospital, Kansas City, MO
  • Ashley Cooper, MD – University of Texas Southwestern Medical School, Dallas, TX
  • Leonard Dragone, MD, PhD – National Jewish Hospital, Denver, CO
  • Anna Huttenlocher, MD – University of Wisconsin Medical School, Madison, WI
  • Karla Jones, RN, MS, CPNP – Nationwide Children’s Hospital, Columbus, OH
  • Karen Kolba, MD – Pacific Arthritis Center, Santa Maria, CA
  • Lakshmi Moorthy, MD, MS – Robert Wood Johnson Medical School, New Brunswick, NJ
  • Peter Nigrovic, MD – Brigham and Women’s Hospital, Boston, MA
  • Kelly Rouster-Stevens, MD – Emory Children’s Center, Atlanta, GA
  • Jennifer Stinson, RN, PhD, CPNP – The Hospital for Sick Children, Toronto, ON, CA

American College of Rheumatology Pediatric Rheumatology Core Membership Group*

* Members of the Core Membership Group included: Robert Colbert, MD, PhD, Randy Cron, MD, PhD, Peter Dent, MD, Melissa Elder, MD, PhD, Don Goldsmith, MD, Roger Hollister, MD, Norman Ilowite, MD, Yukiki Kimura, MD, Marisa Klein-Gittelman, MD, MPH, Erica Lawson, MD, Murray Passo, MD, Ross Petty, MD, PhD, Marilynn Punaro, MD, Egla Rabinovich, MD, MPH, Andreas Reiff, MD, David Sherry, MD, Larry Zemel, MD.

Sources

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. AHRZ 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.