American College of Rheumatology – Pediatric Rheumatology
View all recommendations from this societyReleased October 27, 2013
Don’t repeat a confirmed positive ANA in patients with established JIA or systemic lupus erythematosus (SLE).
ANA is important in the diagnosis of SLE and positivity guides more frequent slit lamp examination for detection of uveitis in children with JIA. Beyond this, there is no evidence that ANA is valuable in the ongoing management of SLE or JIA. It is recommended that following diagnosis of SLE or JIA, ANA should not be repeated unless a child with JIA has evolution of symptoms suggestive of an autoimmune connective tissue disease.
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
Petty RE, Cassidy JT, Sullivan DB. Clinical correlates of antinuclear antibodies in juvenile rheumatoid arthritis. J Pediatr 1973;83:386–9.
Cassidy J, Kilvin J, Lindsley C, Nocton J. Ophthalmologic examinations in children with juvenile rheumatoid arthritis. Pediatrics. 2006;117:1843–5.
Ravelli A, Varnier GC, Oliveira S, Castell E, Arguedas O, Magnani A, Pistorio A, Ruperto N, Magni-Manzoni S, Galasso R, Lattanzi B, Dalprà S, Battagliese A, Verazza S, Allegra M, Martini A. Antinuclear antibody-positive patients should be grouped as a separate category in the classification of juvenile idiopathic arthritis. Arthritis Rheum. 2011;63:267–75.
Ferraz MB, Goldenberg J, Hilario M, Bastos WA, Oliveira SK, Azevedo EC, di Napoli D. Evaluation of the 1982 ARA lupus criteria data set in pediatric patients. Committees of Pediatric Rheumatology of the Brazilian Society of Pediatrics and the Brazilian Society of Rheumatology. Clin Exp Rheumatol. 1994;12:83–7.
