Testing is an integral part of the diagnosis and management of patients with rheumatic disease. However, in this era of increased focus on healthcare costs, it is important to understand exactly how tests affect the delivery and costs of care. Along these lines, the American Board of Internal Medicine has begun the Choosing Wisely program with the goal “of advancing a national dialogue on avoiding wasteful or unnecessary medical tests, treatments and procedures”1. Multiple agencies in the United States and Canada are participating in this campaign, including the American College of Rheumatology (ACR), which has created a set “Five Things that Physicians and Patients Should Consider” in rheumatology-related testing2. These are important efforts, which hopefully will ultimately lead to improved clinical care, as well as improved costs of care, based on sound scientific investigations.
Two tests that are used often in the evaluation of inflammatory arthritis (IA) are rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA), with both of these tests being included in the 2010 ACR/European League Against Rheumatism (EULAR) classification criteria for rheumatoid arthritis (RA)3. Notably, these autoantibody tests are not included in the Choosing Wisely campaign. However, in the Canadian healthcare system, ACPA testing is not uniformly paid for, and as such a subset of patients with IA and RA do not have this testing performed. This has led to an opportunity for Shu and colleagues, whose report is published in the November 2015 issue of The Journal4, to catch the spirit of the Choosing Wisely campaign and to explore the relationship between ACPA testing and the short-term management …
Address correspondence to Dr. K.D. Deane, University of Colorado Denver, Anschutz Medical Campus, Division of Rheumatology, Department of Medicine, 1775 Aurora Court, Mail Stop B-115, Aurora, Colorado 80045, USA. E-mail: Kevin.Deane{at}UCDenver.edu