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

Sidiropoulos, Prodromos; Hatemi, Gülen; Song, In‐Ho; Avouac, Jérôme; Collantes, Eduardo; Hamuryudan, Vedat; Herold, M; Kvien, Tore K; Mielants, Herman; Mendoza, Juan Mulero; Olivieri, Ignazio; Østergaard, Mikkel; Schachna, Lionel; Sieper, Joachim; Boumpas, DT; Dougados, Maxime

doi:10.1093/rheumatology/kem348

Cited by 95 publications

(51 citation statements)

References 73 publications

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“…Our paper summarizes the recommendations and constitutes the most practical comprehensive consensus for the practicing physician. Our paper is similar to other published recommendations involving multiple clinically relevant questions such as those in the 3e Initiative in Rheumatology 8,9,10,11,12 . Likewise, the 3e initiative led to subsequent publications detailing the most relevant clinical questions and findings.…”

Section: To the Editorsupporting

confidence: 81%

Limitations in the Full Reporting of Systematic Literature Review

HARAOUI

2016

J Rheumatol

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Section: To the Editorsupporting

confidence: 81%

Limitations in the Full Reporting of Systematic Literature Review

HARAOUI

2016

J Rheumatol

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“…A positive result in this setting will not classify the person as having SpA because the diagnosis is of low probability 27 . In fact, the posttest probability of this test in a patient with chronic low back pain alone would not exceed 30% 22 . Alternatively, with the appropriate combination of clinical, laboratory (e.g., CRP), and imaging findings, the pretest probability of SpA increases to at least 80-90% 26 .…”

Section: Rheumatologymentioning

confidence: 95%

“…Level of evidence: grade IIB. Supported by the Assessment of SpondyloArthritis International Society (ASAS) 20,21 and the 3E Initiative in Rheumatology 22 .…”

Section: Do Not Order An Hla-b27 Unless Spondyloarthritis (Spa)mentioning

confidence: 99%

See 1 more Smart Citation

Choosing Wisely: The Canadian Rheumatology Association’s List of 5 Items Physicians and Patients Should Question

Sl¹,

J²,

Mj³

et al. 2015

J Rheumatol

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Objective.To develop a list of 5 tests or treatments used in rheumatology that have evidence indicating that they may be unnecessary and thus should be reevaluated by rheumatology healthcare providers and patients.Methods.Using the Delphi method, a committee of 16 rheumatologists from across Canada and an allied health professional generated a list of tests, procedures, or treatments in rheumatology that may be unnecessary, nonspecific, or insensitive. Items with high content agreement and perceived relevance advanced to a survey of Canadian Rheumatology Association (CRA) members. CRA members ranked these top items based on content agreement, effect, and item ranking. A methodology subcommittee discussed the items in light of their relevance to rheumatology, potential effect on patients, and the member survey results. Five candidate items selected were then subjected to a literature review. A group of patient collaborators with rheumatic diseases also reviewed these items.Results.Sixty-four unique items were proposed and after 3 Delphi rounds, this list was narrowed down to 13 items. In the member-wide survey, 172 rheumatologists responded (36% of those contacted). The respondent characteristics were similar to the membership at large in terms of sex and geographical distribution. Five topics (antinuclear antibodies testing, HLA-B27 testing, bone density testing, bone scans, and bisphosphonate use) with high ratings on agreement and effect were chosen for literature review.Conclusion.The list of 5 items has identified starting points to promote discussion about practices that should be questioned to assist rheumatology healthcare providers in delivering high-quality care.

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“…The 3E group objective is to allow that the suggested recommendations reflect, after extensive discussion and vote, the opinion of many rheumatologists from different countries who formulate the recommendations after awareness of the evidence already presented. 2 Other objectives of the 3E group are to discuss the differences between countries in the creation of these recommendations, and also to promote the dissemination of epidemiology basic concepts in the rheumatologist community. Specifically in this study, the main objective was to create recommendations on the use of methotrexate in patients with RA and other rheumatic diseases.…”

Section: Introductionmentioning

confidence: 99%

Recomendações nacionais baseadas em evidências científicas e opiniões dos especialistas sobre o uso do metotrexato nas doenças reumáticas, especialmente na artrite reumatoide: resultados da iniciativa 3E do Brasil

Pereira¹,

Cruz²,

Xavier³

et al. 2009

Rev. Bras. Reumatol.

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Objectives: The use of methotrexate (MTX) has been the basis for rheumatoid arthritis (RA) therapy, but there is no uniformity on the guidelines for its clinical use. The objective of this study was to develop recommendations based on scientific evidence and opinions of experts on the use of MTX, which will allow the improvement of our clinical practice. Methods: 3E (Evidence, Expertise, Exchange) Initiative in Rheumatology is a multinational group of rheumatologists from 17 countries, including Brazil. After a selection of 10 questions about the use of MTX, held by the Delphi method, a systematic literature review (SLR) was done (Medline, Pubmed, Embase, Cochrane, Abstracts EULAR 2005 and ACR 2006 by six international bibliographic reviewers chosen by the mentors of the 3E study. Two other different national questions from Brazil were also included, and the SLR was done by a national bibliographic reviewer.** The results of SLR were presented by 7 members of our Brazilian 3E scientific committee* at a meeting of 48 rheumatologists, which discussed RSL details, voted, and produced the national recommendations presented here. These recommendations were subsequently used in the creation of multinational recommendations. Results and conclusions: 21 recommendations concerning the 10 international and the 2 national questions were formulated, with an agreement level of 77% among the participants (63-100%). Oral MTX should be started at a minimum dose of 10 mg/wk and a maximum dose of 25 mg/wk. Elevation of AST/ALT above 3x the upper limit, for at least 3 times consecutively, justifies the temporary suspension of MTX, which can be restored after normalization of serum liver enzyme levels; MTX is safe for long term use. The use of alcohol (100 g/wk) should be avoided. Combinations of MTX with disease modifying antirheumatic drugs are recommended, although there is risk of greater toxicity. Folic acid should be associated with MTX in dose higher than 5 mg/wk. Total blood cell count, creatinine, AST/ALT, serology for hepatitis B and C virus, and chest X-ray should be ordered before initiating MTX. Inquire about contraception methods, comorbidities, use of Pereira et al. 354Bras J Rheumatol 2009;49(4):346-61 illicit drugs, alcohol, and liver diseases and hepatotoxic drugs should be performed. The MTX can be maintained during elective surgeries; discontinuation of MTX for at least 3 months before planning of pregnancy is suggested, for both men and women Use of contraception method is justified with the use of MTX in reproductive age. MTX can be used to reduce the cumulative dose of corticosteroid in patients with giant cell arthritis, rheumatic polymyalgia (RPM), juvenile dermatomyositis, and in systemic lupus erythematosus (SLE) with cutaneous or joint involvement.

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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

Cited by 95 publications

References 73 publications

Limitations in the Full Reporting of Systematic Literature Review

Limitations in the Full Reporting of Systematic Literature Review

Choosing Wisely: The Canadian Rheumatology Association’s List of 5 Items Physicians and Patients Should Question

Recomendações nacionais baseadas em evidências científicas e opiniões dos especialistas sobre o uso do metotrexato nas doenças reumáticas, especialmente na artrite reumatoide: resultados da iniciativa 3E do Brasil

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