Fewer rheumatological tests required


New medical advice released by the Royal Australasian College of Physicians (RACP) has the potential to reduce the number of tests used for diagnosing rheumatological conditions.

Dr Rebecca Grainger, an academic rheumatologist and senior Fellow with the RACP, discussed the new recommendations today at the Council of Medical Colleges in New Zealand meeting in Wellington on behalf of the New Zealand Rheumatology Association (NZRA) and the RACP.

“Testing for auto-antibodies, which are likely to cause rheumatological conditions, can involve two tests - the extractable nuclear antibodies (ENA) test and the anti-double stranded (ds) DNA (anti-dsDNA) antibodies test,” Dr Grainger said.

“The latest recommendations suggest that doctors should not routinely order these tests for patients who have already tested negative for a more general antibody test, the antinuclear antibody test.

“While this testing does not harm a patient, it is unnecessary, causes anxiety when unnecessary tests show false positive results, and takes up time and resources that could be better used elsewhere in the healthcare system.

“There are some specific exceptions to this rule. ENA testing in patients who have already tested negative for antinuclear antibodies could be warranted where the doctor has a high clinical suspicion of an autoimmune condition.”  

It’s projected that the new recommendations, which are consistent with international guidelines, could lead to a 10 per cent reduction in these kinds of diagnostic tests each year. In Wellington alone, this would mean at least 650 fewer tests.

The advice is among five recommendations released today and are a part of the RACP’s broader Evolve initiative and a contribution to the CMC NZ’s Choosing Wisely initiative which both share similar objectives of identifying and reducing low value or inappropriate use of tests and treatments. 

Read the full list of recommendations from the NZRA here.

There are now 20 Evolve lists published, with further ‘Top Five’ lists in development. For more information, visit: https://evolve.edu.au.

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