What are the core recommendations for rheumatoid arthritis care? Systematic review of clinical practice guidelines.

Autor: Conley B; Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia. bccon@student.unimelb.edu.au., Bunzli S; Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia.; School of Health Sciences and Social Work, Griffith University, Brisbane, QLD, Australia.; Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia., Bullen J; EnAble Institute, Curtin University, Perth, WA, Australia., O'Brien P; Department of Surgery, The University of Melbourne, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia., Persaud J; Arthritis and Osteoporosis Western Australia, Perth, WA, Australia.; Physiotherapy Department, Sir Charles Gairdner Hospital, Nedlands, WA, Australia., Gunatillake T; Department of Surgery, The University of Melbourne, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia., Nikpour M; Departments of Medicine and Rheumatology Melbourne, The University of Melbourne at St. Vincent's Hospital, Melbourne, VIC, Australia., Grainger R; Department of Medicine, University of Otago Wellington, Wellington, New Zealand.; Te Whatu Ora Health New Zealand - Capital Coast and Hutt Valley, Wellington, New Zealand., Barnabe C; Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada., Lin I; Western Australian Centre for Rural Health, The University of Western Australia, Geraldton, WA, Australia.; Geraldton Regional Aboriginal Medical Service, Geraldton, WA, Australia.
Jazyk: angličtina
Zdroj: Clinical rheumatology [Clin Rheumatol] 2023 Sep; Vol. 42 (9), pp. 2267-2278. Date of Electronic Publication: 2023 Jun 09.
DOI: 10.1007/s10067-023-06654-0
Abstrakt: Systematic r eview to evaluate the quality of the clinical practice guidelines (CPG) for rheumatoid arthritis (RA) management and to provide a synthesis of high-quality CPG recommendations, highlighting areas of consistency, and inconsistency. Electronic searches of five databases and four online guideline repositories were performed. RA management CPGs were eligible for inclusion if they were written in English and published between January 2015 and February 2022; focused on adults ≥ 18 years of age; met the criteria of a CPG as defined by the Institute of Medicine; and were rated as high quality on the Appraisal of Guidelines for Research and Evaluation II instrument. RA CPGs were excluded if they required additional payment to access; only addressed recommendations for the system/organization of care and did not include interventional management recommendations; and/or included other arthritic conditions. Of 27 CPGs identified, 13 CPGs met eligibility criteria and were included. Non-pharmacological care should include patient education, patient-centered care, shared decision-making, exercise, orthoses, and a multi-disciplinary approach to care. Pharmacological care should include conventional synthetic disease modifying anti-rheumatic drugs (DMARDs), with methotrexate as the first-line choice. If monotherapy conventional synthetic DMARDs fail to achieve a treatment target, this should be followed by combination therapy conventional synthetic DMARDs (leflunomide, sulfasalazine, hydroxychloroquine), biologic DMARDS and targeted synthetic DMARDS. Management should also include monitoring, pre-treatment investigations and vaccinations, and screening for tuberculosis and hepatitis. Surgical care should be recommended if non-surgical care fails. This synthesis offers clear guidance of evidence-based RA care to healthcare providers. TRIAL REGISTRATION: The protocol for this review was registered with Open Science Framework ( https://doi.org/10.17605/OSF.IO/UB3Y7 ).
(© 2023. Crown.)
Databáze: MEDLINE
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