Evidence-based recommendations for the management of ankylosing spondylitis: systematic literature search of the 3E Initiative in Rheumatology involving a broad panel of experts and practising rheumatologists |
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| Authors: | Sidiropoulos P I Hatemi G Song I-H Avouac J Collantes E Hamuryudan V Herold M Kvien T K Mielants H Mendoza J M Olivieri I Østergaard M Schachna L Sieper J Boumpas D T Dougados M |
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| Affiliation: | 1Department of Internal Medicine, Division of Rheumatology, Clinical Immunology and Allergy, University of Crete, Medical School, Heraklion, Greece, 2Cerrahpasa Medical Faculty, University of Istanbul, Istanbul, Turkey, 3Department of Medicine, Rheumatology, Charite, University Medicine Berlin, Germany, 4Rheumatology Department, Cochin Teaching Hospital, School of Medicine, Paris-Descartes University, Paris, France, 5Department of Rheumatology, Reina Sofia University Hospital of Cordoba, Cordoba, Spain, 6Clinical Department of Internal Medicine, Division of General Internal Medicine, Innsbruck Medical University, Austria, 7Department of Rheumatology, Diakonhjemmet Hospital, Box 23 Vinderen, N-0319 Oslo, Norway, 8Department of Rheumatology, Ghent University Hospital, Gent, Belgium, 9Servicio de Reumatologia, Hospital Puerta de Hierro, Madrid, Spain, 10Rheumatology Department of Lucania, San Carlo Hospital of Potenza, Potenza, Italy, 11Copenhagen University Hospital, Copenhagen, Denmark and 12Austin Spondylitis Centre, Austin Health, Melbourne, Victoria, Australia. |
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| Abstract: | Objective. Recommendations and/or guidelines represent a popularway of integrating evidence-based medicine into clinical practice.The 3E Initiatives is a multi-national effort to develop recommendationsfor the management of rheumatic diseases, which involves a largenumber of experts combined with practising rheumatologists addressingspecific questions relevant to clinical practice. Methods. Ten countries participated in three rounds of discussionsand votes concerning the management of AS. A set of nine questionswas formulated in the domains of diagnosis, monitoring and treatment,after a Delphi procedure. A literature search in MedLine wasconducted. Predefined outcome parameters for the domains ofdiagnosis, monitoring and treatment were assessed. The evidenceto support each proposition was evaluated and scored. Afterdiscussion and votes, the final recommendations were presentedusing brief statements by each national group, following whichthe final international recommendations were formulated. Results. A total of 2699 papers were found and 467 were selectedfor analysis. Twelve key recommendations were developed: threein the domain of diagnosis addressing general diagnostic considerations,early AS diagnosis and general practitioners referralrecommendations; three concerning monitoring of AS disease activity,severity and prognosis; six concerning pharmacological treatment(except biologics): non-steroidal anti-inflammatory drugs/COX-IIinhibitors, bisphosphonates and treatment of enthesitis. Thecompiled agreement among experts ranged from 72% to 93%. Conclusion. Recommendations for the management of AS were developedusing an evidence-based approach followed by expert/physicianconsensus with high level of agreement. Involvement of a largerand more representative group of rheumatologists may improvetheir dissemination and implementation in daily clinical practice. KEY WORDS: Ankylosing spondylitis, Systemic literature search, Recommendations, Non-steroidal anti-inflammatory drugs, COX-II inhibitors, Monitoring, Diagnosis, Treatment |
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