Before agreeing on specific tests, procedures or treatments, rheumatologists and patients need to be aware of the top five that should be questioned, according to a list compiled by the American College of Rheumatology as part of the "Choosing Wisely" campaign.

Led by the American Board of Internal Medicine Foundation, the Choosing Wisely campaign involves more than 35 medical specialty groups and is intended to encourage patients and doctors to discuss appropriate care while avoiding unnecessary tests and treatments. The American College of Rheumatology (ACR) is one of 17 medical societies that recently released advice lists as part of the campaign.

"Rheumatology is a very complex field, and rheumatic conditions can be very difficult to treat," Dr. Kenneth Saag, a professor in the division of clinical immunology and rheumatology at the University of Alabama at Birmingham, said in a university news release.

A rheumatologist is a doctor trained in the diagnosis and treatment of arthritis and other musculoskeletal diseases that affect the joints, muscles and bones.

The ACR's top-five list "offers a strong starting point for evaluation and conversation about providing the most effective care to the more than 50 million Americans with arthritis and rheumatic diseases," said Saag, who was a co-author of the review and heads the ACR's quality of care committee that oversaw the process.

The ACR's list, published recently in the journal Arthritis Care & Research, includes tests and treatments that are commonly ordered or provided by rheumatologists; are among the most expensive services; and have been shown not to provide any meaningful benefit in certain patients.

Here is the ACR's list:

• Do not test for Lyme disease as a cause of musculoskeletal symptoms without an exposure history and appropriate exam findings. False-positive tests can lead to unnecessary treatment.
• Do not perform an MRI of the peripheral joints to routinely monitor inflammatory arthritis. Standard X-ray and activity assessments are more cost effective.
• Do not prescribe biologic drugs for rheumatoid arthritis before a trial of methotrexate or other conventional non-biologic drugs. Many patients respond to standard treatment.
• Do not repeat Dual-energy X-ray absorptiometry (DEXA) scans more often than once every two years. This screening is done for osteoporosis.
• Do not perform the blood test known as anti-nuclear antibody (ANA) sub-serologies without a positive ANA and clinical suspicion of immune disease. Broad testing of antibodies should be avoided.