Our initial assessment of the VIC rheumatology modules was positive, supporting their role as an effective tool in teaching an approach to rheumatology patients, with an emphasis on resource stewardship. Future directions include the expansion of cases, based on feedback, wider dissemination and an evaluation of learning retention.

The aim of the European Journal of Rheumatology is to cover various aspects of rheumatology for its readers, encompassing the spectrum of diseases with arthritis, musculoskeletal conditions, autoinflammatory diseases, connective tissue disorders, osteoporosis, translational research, the latest therapies and treatment programs. European Journal of Rheumatology publishes original articles, invited reviews, case based reviews, letters to the editor and images in rheumatology. The publication language of the journal is English. Accepted manuscripts are copy-edited for grammar, punctuation, and format. Once the publication process of a manuscript is completed, it is published online on the journal's webpage as an aheadof-print publication before it is included in its scheduled issue. A PDF proof of the accepted manuscript is sent to the corresponding author and their publication approval is requested within 2 days of their receipt of the proof.

aboratory testing is the highest-volume medical procedure, 1 and volumes are increasing annually. 2,3 It has been estimated that 20% of tests are ordered unnecessarily. 4,5 Misuse of laboratory tests is a major challenge affecting the sustainability of health care. 6,7 Improving the appropriateness of rheumatology laboratory testing is a priority of Choosing Wisely campaigns. 8,9 Concerns have been raised about the inappropriate use of antinuclear antibody (ANA) testing. Testing for ANA is indicated only if a patient's clinical history and physical examination show symptoms or signs suggestive of systemic lupus erythematosus, scleroderma, Sjögren syndrome, polymyositis or dermatomyositis. 10,11 The test has high sensitivity, and, thus, a positive test result can contribute to a diagnosis of these conditions. 12 However, it has low specificity, and ANA and can be seen in other conditions and in more than 20% of healthy people, 13 which makes interpretation of test results challenging. 12 Choosing Wisely Canada recommends that "ANA testing should not be used to screen subjects without specific symptoms or without a clinical evaluation that may lead to a diagnosis of systemic lupus or other connective tissue disease." 8 International recommendations strongly advise that "ANA testing is primarily intended for diagnostic purposes, and not for monitoring disease progression" owing to its limited value in monitoring disease activity. 14-17 Thus, it is not appropriate to repeat ANA following a positive test result. 7-9,16,18

No abstract

Supplemental digital content is available in the text.

No abstract

We present a case of an elderly, immunosuppressed patient with rheumatoid arthritis who was not appropriately vaccinated, and subsequently developed herpes zoster ophthalmicus, which initially presented similar to giant cell arteritis. Evidence-based vaccinations are integral in decreasing the incidence of preventable diseases and promoting optimal health at the individual and population level. Although the patient ultimately did not suffer any long-term adverse sequelae, this case highlights the importance of vaccination in the rheumatology setting, and to consider both inflammatory and infectious causes of headache and vision changes in the elderly. K E Y W O R D Sgiant cell arteritis, herpes zoster ophthalmicus, rheumatology, vaccination

1 Vaccination status should be assessed at diagnosis and periodic examinations in patients with rheumatic diseases Patients with rheumatic disease have 1.4-2.0 times the risk of infection as the general population. 1 Although vaccination is recommended for all patients with rheumatic disease, uptake is suboptimal. 2 2 Inactivated vaccines are safe and generally effective in patients receiving disease-modifying antirheumatic drugs Inactivated vaccines, including influenza, pneumococcal, tetanus, human papillomavirus, Haemophilus influenzae type B, meningococcal and hepatitis A and B, are safe in patients receiving conventional synthetic disease-modifying antirheumatic drugs (DMARDs) and biologic DMARDs. 2 Data on vaccine response in patients receiving DMARDs are limited. Meta-analysis suggests diminished response to pneumococcal vaccination with methotrexate but not tumour necrosis factor inhibitors. 3