1. 1

    Do not perform arthroscopy with lavage and/or debridement or partial meniscectomy for patients with symptomatic osteoarthritis of the knee and/or degenerative meniscal tear

  2. 2

    Do not prescribe more than the minimum effective dose of glucocorticoid (GC) therapy (10-20 mg daily) for initial treatment of polymyalgia rheumatica (PMR)

  3. 3

    Do not repeat dual-energy X-ray absorptiometry (DEXA) scans for diagnosis of osteoporosis more frequently than every 5 years in patients in good health, with no risk factors for accelerated bone loss or fracture and with T scores greater than - 2.00

  4. 4

    Do not order extractable nuclear antibodies (ENA) testing in patients with negative antinuclear antibodies (ANA)

  5. 5

    Do not order anti-double stranded (ds) DNA antibodies in antinuclear antibody (ANA) negative patients unless clinical suspicion of systemic lupus erythematosus (SLE) remains high

How this list was developed

A working group of NZRA Fellows was established and developed an initial list of recommendations on 44 rheumatology-related tests and treatments that might be low-value informed by an evidence review by the Royal Australasian College of Physicians Policy and Advocacy unit. This list was reduced to 26 items following further discussions, and a shortlist of 15 items was agreed following further polling of the group. Brief synopses of the evidence were written for each of the 15 recommendations and an anonymous online survey was created based on these. All NZRA members were invited to participate and assign a score for each of the recommendations based on the criteria of (i) whether the practice was still being undertaken in significant numbers (ii) strength of the evidence for the recommendation (iii) importance of the recommendation to safety and cost (iv) whether progress in implementing the change would be measurable. Based on the results of the survey, the top 5 was selected and approved by the NZRA working group and the NZRA President in June 2018.