Littérature scientifique sur le sujet « EULAR guideline »
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Articles de revues sur le sujet "EULAR guideline"
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Chaplin, Steve. « Summary of the new EULAR rheumatoid arthritis guideline ». Prescriber 31, no 9 (septembre 2020) : 15–19. http://dx.doi.org/10.1002/psb.1863.
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Lee, M., G. Reynolds, M. Yates et J. Galloway. « POS1448 EVIDENCE BASED PRACTICE : WHAT IS THE EVIDENCE THAT BRITISH SOCIETY FOR RHEUMATOLOGY GUIDELINES ARE EVIDENCE BASED ? » Annals of the Rheumatic Diseases 80, Suppl 1 (19 mai 2021) : 1008.2–1008. http://dx.doi.org/10.1136/annrheumdis-2021-eular.822.
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Background:Clinical practice guidelines are designed to ensure that patients are treated according to best evidence, with the goal of optimizing clinical outcomes and reducing unwarranted variation in care. They compile, rate and translate the data available into recommendations that form the basis of evidence-based practice for most clinicians. Despite their importance, the evidence base informing different guidelines varies in quality. A recent study of American College of Rheumatology (ACR) Practice Guidelines demonstrated only 17 of 35 class I (strong benefit to harm ratio) recommendations were supported by level A evidence (high quality randomized controlled trails or meta-analyses)1.Objectives:To review the evidence supporting the British Society for Rheumatology (BSR) guidelines.Methods:Thirteen sets of guidelines that were available on the BSR website as of October 16th 2019 were reviewed (https://www.rheumatology.org.uk/practice-quality/guidelines). A range of methodologies (including Grading of Recommendations Assessment, Development and Evaluation (GRADE), Scottish Intercollegiate Guidelines Network (SIGN), EULAR and Royal College of Physicians (RCP) recommendations) were used to assess the quality of evidence and strength of recommendation. For comparability between guidelines the level of evidence was converted to a score between I (highest quality) and IV (lowest quality) and the strength of recommendation was converted to a rating between A and D. The polymyalgia rheumatica guideline was not assessed due to unclear methodology and lack of level of evidence for all recommendations.Results:Of the 12 BSR guidelines assessed, there were 554 recommendations in total. The number of recommendations per guideline ranged between 13 and 80. Across all assessed guidelines, 94 recommendations (17.0%) were classified as level I, 161 (29.1%) as level 2 and 299 (54.0%) as level 3 or 4. These figures are similar to those reported in the ACR guidelines (23%, 19% and 58% respectively)1. The proportion of level I evidence varied from 46.2% (Axial Spondyloarthropathy guideline) to 0% (Hot Swollen Joint guideline).Conclusion:Over half of all BSR guideline recommendations have level of supporting evidence of III/IV. A wide range of methodologies are used to generate BSR guidelines (GRADE, SIGN, RCP / EULAR). This makes it challenging for readers unfamiliar with these approaches to interpret evidence and hinders comparisons between guidelines. A standardized methodology for future guideline development would overcome these barriers.References:[1]Duarte-Garcia A, Zamore R & Wong JB. The Evidence Basis for the American College of Rheumatology Practice Guidelines. JAMA Intern Med, 2018 Jan 1;178(1):146-148.Disclosure of Interests:None declared
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Babatunde, O., S. Dawson, A. Adebajo et K. Dziedzic. « OP0191 CONCEPTUALISING PATIENT AND PUBLIC INVOLVEMENT IN MUSCULOSKELETAL GUIDELINES IMPLEMENTATION : THE ALLIANCE FRAMEWORK ». Annals of the Rheumatic Diseases 81, Suppl 1 (23 mai 2022) : 127.2–127. http://dx.doi.org/10.1136/annrheumdis-2022-eular.48.
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BackgroundPatient and Public Involvement (PPI), have supported high quality Rheumatology research which have now been successfully curated into widely endorsed evidence-based recommendations and guidelines. However, uptake and applicability of guidelines is less than optimal, significant variation exist in care, and health and socio-economic burdens attributed to rheumatic conditions continues to rise, suggesting an implementation challenge.ObjectivesWe conducted a rapid review to investigate the role of PPI in guideline implementation.MethodsA comprehensive search for relevant literature was undertaken (three databases - Medline, Embase, Cinahl, and two large repositories -WHO, G-IN). A priori eligibility criteria and systematic review-based methods were used to identify primary studies with explicit reference to PPI involvement in a rheumatic/musculoskeletal - MSK guideline implementation activity. Extracted data from included studies was interrogated for details regarding activities, contexts, outcomes, and impact of PPI in guidelines implementation and further discussed in review project meetings. Findings were brought together in a narrative synthesis. Recommendations for future research and practice, and a conceptual framework for PPI in Rheumatic and MSK guidelines implementation were co-developed with a public contributor.ResultsTen papers were included, only 1 from the global south. A prevalence of consultative PPI activities in guidelines dissemination (e.g., language translations, patient versions) was found. Few studies explicitly report high-level PPI engagement in relation to care pathway adjustments, care commissioning, institutional operations and policy with a view to MSK guideline implementation. Training, development, and practice of PPI in MSK guideline implementations were not evidenced to have spread much beyond Europe and are also not well reported in literature nor rightly accrued as PPI activities in guideline implementation. The alliance framework (Figure 1) highlighting an iterative process of “creative thinking/co-production” and “strategic doing” helps to conceptualise PPI in MSK guideline implementation. The framework guides knowledge translation from guidelines to real world practice and aims to drive quality improvement for MSK care with patients, for patients, across and within care settings globally.Figure 1.The Alliance framework for conceptualising Patient and Public Involvement in Rheumatic and Musculoskeletal guidelines implementation.ConclusionDespite success of PPI in rheumatology/MSK research, oversight or ineffective PPI in guideline implementation may hamper translation of novel advances in MSK care into real world practice and patient benefit. The Alliance framework prioritises effective PPI in MSK guideline implementation design, delivery, and evaluation, ideally applied in parallel with the development of evidence-based guidance recommendations. It highlights continuous application of innovative thinking, dynamic, and impactful collaborations for bridging the evidence-practice gap and improving quality of care for MSK patients globally through novel partnerships.Disclosure of InterestsNone declared
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Bailly, F., A. P. Trouvin, S. Bercier, S. Dadoun, J. P. Deneuville, R. Faguer, J. B. Fassier et al. « THU0486 2019 FRENCH GUIDELINES AND CARE PATHWAY ABOUT LOW BACK PAIN MANAGEMENT IN ADULTS ». Annals of the Rheumatic Diseases 79, Suppl 1 (juin 2020) : 481.1–481. http://dx.doi.org/10.1136/annrheumdis-2020-eular.2408.
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Background:Low back pain (LBP) is a frequent, disabling symptom, for which the risk of chronicity is increased by heterogeneous care. Developing and implementing recommendations is likely to improve LBP management.Objectives:To develop French guidelines and care pathway on the management of LBP, coordinated by the French National Authority for Health (FNAH) and based on previous international guidelines in addition to update literature.Methods:A compilation report was constituted on the basis of a systematic review of guidelines between January 2013 and December 2018, and systematic reviews and meta-analysis in the field of LBP between January 2015 and December 2018. This report summarized the state-of-the-art for each predefined area of the guideline. A panel of experts including patients’ representatives and 19 health professionals involved in LBP management was constituted to elaborate the guideline based on the compilation report. A care pathway was constituted to identify the trajectory and the different steps followed by a patient with LBP. Then, the compilation report and the preliminary guidelines were submitted to 24 academic institutions and stakeholders for feedback. Based on the preliminary guideline and the responses of academic institutions and stakeholders, the final recommendations were drawn up by the expert panel. The guideline was finally submitted to an independent committee of the FNAH for final validation. For each area of the guidelines, agreement between experts of the working group was evaluated through the RAND/UCLA method.Results:The initial literature search identified 572 references of recent international guidelines or systematic reviews about LBP. After selection, the compilation report included 101 references. The compilation report was submitted to the expert group during 3 different meetings to reach a consensus on different topics. Thirty-one preliminary recommendations and a care pathway (divided in two parts to facilitate its use and readability) were drafted and submitted to academic institutions and stakeholders. Having considered their comments, final recommendations and care pathway were written. The final guideline was validated by the FNAH. Then, the consensus of the expert panel was assessed about all the final guidelines separately: 32 recommendations (including the care pathway) were evaluated as appropriate; none were evaluated uncertain or inappropriate. Strong approval was obtained for 27 of them (including the care pathway) and weak for 5 of them.Conclusion:This new LBP guideline was based on recent scientific evidence. It introduced several concepts, including the need to identify low back pain at risk of chronicity, in order to provide quicker intensive management if necessary. This guideline should be updated in 5 years’ time, in order to keep it in line with ongoing scientific evidence.Disclosure of Interests: :Florian Bailly Consultant of: Consultation fees from Lilly and Grünenthal laboratories, Anne Priscille Trouvin Speakers bureau: Speaker for menarini, recordati, pfizer, astellas, Sandrine Bercier: None declared, Sabrina Dadoun: None declared, Jean Philippe Deneuville: None declared, Rogatien Faguer: None declared, Jean Baptiste Fassier: None declared, Michèle Koleck: None declared, Louis Lassalle: None declared, Thomas Le Vraux: None declared, Brigitte Liesse: None declared, Karine Petitprez: None declared, Aline Ramond: None declared, Jean François Renard: None declared, Alexandra Roren: None declared, Sylvie Rozenberg Consultant of: Pfizer, Catherine Sebire: None declared, Gilles Viudes: None declared, François Rannou Grant/research support from: Pierre Fabre, Fidia, MSD, Pfizer, Bone Therapeutics, Expanscience, Grunenthal, Thuasne, Genévrier, Fondation Arthritis, Consultant of: Pierre Fabre, Fidia, MSD, Pfizer, Bone Therapeutics, Expanscience, Grunenthal, Thuasne, Genévrier, Speakers bureau: Pierre Fabre, Fidia, MSD, Pfizer, Bone Therapeutics, Expanscience, Grunenthal, Thuasne, Audrey Petit: None declared
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DeLoughery, Thomas. « Guideline : EULAR provided recommendations for thrombotic and obstetric antiphospholipid syndrome ». Annals of Internal Medicine 171, no 6 (17 septembre 2019) : JC26. http://dx.doi.org/10.7326/acpj201909170-026.
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Bautista-Molano, W., E. Jauregui, L. Saldarriaga, M. X. Rojas et J. R. Pieschacón. « THU0557 QUALITY ASSESSMENT OF CLINICAL PRACTICE GUIDELINES IN AXIAL AND PERIPHERAL SPONDYLOARTHRITIS : A SYSTEMATIC APPRAISAL ». Annals of the Rheumatic Diseases 79, Suppl 1 (juin 2020) : 519.2–520. http://dx.doi.org/10.1136/annrheumdis-2020-eular.5520.
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Background:Clinical practice guidelines (CPG) in spondyloarthritis (SpA) serves as a tool for rheumatologists, health-care providers and patients in the selection of appropriate treatment framework in common clinical scenarios guiding decision-making processes. However, the quality of these guidelines has not yet been evaluated systematically in the field.Objectives:The aim of the study was to evaluate the quality of the CPG available for the treatment of axial and peripheral SpA.Methods:A systematic and scientific literature search between 2014 and 2019 was performed in order to identify and select CPG focused on the treatment of axial and peripheral SpA. The authors systematically searched the main guideline databases and guideline developer websites completing the search in PUBMED/MEDLINE and EMBASE. Four independent reviewers with methodological and clinical expertise in the field of SpA, assessed the eligible guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. Their degree of agreement was evaluated with the intra-class correlation coefficient (ICC). The statistical analyses as done using the R psych package.Results:Twelve CPG were selected for evaluation. The scores for each of the AGREE II domains were: scope and purpose 86% (range: 67–99%); stakeholder involvement 71% (range: 22–93%); rigour of development 61% (range: 29–82%); clarity and presentation 79% (range: 68–86%); applicability 48% (range: 21–71%); and editorial independence 72% (range: 19–92%). Most of the appraised guidelines could be recommended (n=12) or recommended with limitations (n=12) for use in clinical practice. The overall agreement among reviewers was moderate (ICC: 0.40; 95% CI 0.16 to 0.82). The CPG with the best quality assessment using the AGREE II instrument was the NICE guideline developed by the National Institute for Health and Care Excellence. A slightly higher quality assessment of CPG developed by research agencies or guideline developers was observed, in comparison to those developed by scientific societies. Figure 1..ssessment cientific societies.eld of ocieties and XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXConclusion:Quality assessment of guidelines for the treatment of axial and peripheral SpA is good with an average of 69%. However, a cut-off point has not been clearly established. Measures should be taken to assure that CPGs are based on the best available evidence and rigorously developed and reported. Additional efforts are needed to provide high-quality guidelines that serve as a useful and reliable instrument for clinical decision-making process in the field of SpA.Disclosure of Interests:None declared
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Henry-Blake, C., K. Treadwell, S. Parmar, J. Higgs, M. Marshall, J. Edwards et G. Peat. « POS1400 A SYSTEMATIC REVIEW OF INTERNATIONAL GUIDELINES REGARDING THE ROLE OF RADIOGRAPHY IN THE DIAGNOSIS OF OSTEOARTHRITIS ». Annals of the Rheumatic Diseases 80, Suppl 1 (19 mai 2021) : 983.1–983. http://dx.doi.org/10.1136/annrheumdis-2021-eular.3117.
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Background:A substantial proportion of primary care osteoarthritis (OA) consultations are associated with an X-ray request (1,2). Uncertainty exists regarding the ability of radiography to improve a clinical OA diagnosis, and the over-use of radiography may lead to inappropriate referrals due to severe radiographic features that do not correlate with patients’ symptoms. Additionally, there are cost implications of unnecessarily imaging such a prevalent disease. As evidence questions the utility of routine radiography in OA, the extent to which radiography is supported by international guidelines is unknown.Objectives:To undertake a systematic review and narrative synthesis of UK and international guideline recommendations on the role of radiography in the diagnosis of OA.Methods:A systematic search of eleven electronic databases (including EMBASE, MEDLINE CINAHL, Epistemonikos and Guideline Central) and the websites of nine professional organisations (including NICE, Royal College of Radiologists (RCR), EULAR, and the American College of Radiology (ACR)) identified the most recent evidence-based guidelines produced by professional organisations on the role of imaging in OA. Guidelines not addressing the role of radiography in the diagnosis of OA were excluded, as were non-English and spinal OA guidelines. Each title was screened by one reviewer whilst each abstract and full text underwent dual screening. A single reviewer, using a standard proforma, undertook data extraction. Each guideline was independently appraised by two reviewers using the AGREE II tool. A narrative synthesis of the nature and consistency of OA radiographic recommendations was performed.Results:18 evidence-based OA guidelines published between 1998-2019 were included. These guidelines considered OA at any joint (n=8), or at the knee (n=3), hip (n=2), hand (n=2), wrist (n=1), foot (n=1), and ankle (n=1). Seven guidelines were produced by European organisations; four guidelines were produced by EULAR. Guidelines were targeted at general practitioners (n=11), radiologists (n=7), rheumatologist (n=4) and orthopaedic surgeons (n=3). Using the AGREE II tool, the identified guidelines scored highly on rigour of development (mean score 69%) but poorly on applicability (32%). All 18 guidelines recommended X-rays as the first-line modality, where imaging was indicated. A clinical diagnosis of OA without radiographic confirmation was recommended by all eleven guidelines produced by organisations represented general practitioners, with seven guidelines justifying this due to a poor correlation between radiographic features and clinical symptoms. Only three guidelines explicitly discouraged the routine use of radiography for the diagnosis of OA and only two guidelines reassured practitioners of a low probability of missing serious pathology when not routinely requesting radiographs. Guidelines produced by organisations representing radiologists were more supportive of radiography. The ACR recommended radiographic confirmation in patients suspected to have OA at the hand, wrist, hip, knee, ankle, and foot. Conversely, the RCR recommended radiographic confirmation in patients suspected to have OA at the hand, feet, and hip, but not the knee.Conclusion:Differences in guideline recommendations on the utility of radiography in OA appear related to country/region, professional organisation, and joint. The use and utility of radiography in OA may need to be reviewed in light of a shift towards remote consultations, a change that has been accelerated by COVID-19 in many countries.References:[1]Yu D, Jordan K, Bedson J, Englund M, Blyth F, Turkiewicz A et al. Population trends in the incidence and initial management of osteoarthritis: age-period-cohort analysis of the Clinical Practice Research Datalink, 1992–2013. Rheumatology. 2017;56(11):1902-1917.[2]Brand C, Harrison C, Tropea J, Hinman R, Britt H, Bennell K. Management of Osteoarthritis in General Practice in Australia. Arthritis Care & Research. 2014;66(4):551-558Acknowledgements:JJE is funded by an Academic Clinical Lectureship from the National Institute for Health Research (NIHR) for this research project (CL-2016-10-003). The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR, NHS or the UK Department of Health and Social Care.Disclosure of Interests:None declared
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Weijers, Julia M., Sanne A. A. Rongen-van Dartel, Dan M. G. M. F. Hoevenaars, Max Rubens, Marlies E. J. L. Hulscher et Piet L. C. M. van Riel. « Implementation of the EULAR cardiovascular risk management guideline in patients with rheumatoid arthritis : results of a successful collaboration between primary and secondary care ». Annals of the Rheumatic Diseases 77, no 4 (22 novembre 2017) : 480–83. http://dx.doi.org/10.1136/annrheumdis-2017-212392.
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The updated European League Against Rheumatism (EULAR) guideline recommends cardiovascular disease (CVD) risk assessment at least once every 5 years in all patients with rheumatoid arthritis (RA). This viewpoint starts with a literature overview of studies that investigated the level of CVD risk factor (CVD-RF) screening in patients with RA in general practices or in outpatient clinics. These studies indicate that CVD-RF screening in patients with RA is marginally applied in clinical practice, in primary as well as secondary care. Therefore, the second part of this viewpoint describes an example of the successful implementation of the EULAR cardiovascular disease risk management (CVRM) guideline in patients with RA in a region in the south of the Netherlands where rheumatologists and general practitioners (GPs) closely collaborate to manage the cardiovascular risk of patients with RA. The different components of this collaboration and the responsibilities of respectively primary and secondary care professionals are described. Within this collaboration, lipid profile was used as an indicator to assess whether CVD-RF screening was performed in the previous 5 years. In 72% (n=454) of the 628 patients with RA, a lipid profile was determined in the previous 5 years. As part of routine quality control, a reminder was sent to the GP in case a patient with RA was not screened. After sending the reminder letter, in 88% of all patients with RA, CVD risk assessment was performed. This collaboration can be seen as good practice to provide care in line with the EULAR guideline.
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Batšinskaja, D., K. Korve et K. Rannus. « AB1557-HPR DEVELOPING THE GUIDELINE FOR OUTPATIENT APPOINTMENT OF A CLINICAL NURSE SPECIALIST AT THE EAST-TALLINN CENTRAL HOSPITAL RHEUMATOLOGY CENTER. DEVELOPMENT PROJECT. » Annals of the Rheumatic Diseases 81, Suppl 1 (23 mai 2022) : 1878.2–1879. http://dx.doi.org/10.1136/annrheumdis-2022-eular.1321.
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BackgroundRheumatic diseases can increase the economic and social burden on the individual and their relatives’ ones, as well as on the health care system and society. Based on international empirical experience, it can be stated that in an exemplary Rheumatology center, both the outpatient appointment of a (general) nurse and the outpatient appointment of a clinical nurse specialist work as a team. The Rheumatology Center of East Tallinn Central Hospital is the only center in Estonia that specializes in rheumatic patients, where (general) nurses are proceed, but the extent to which the current health care service meets the needs of rheumatic patients has not yet been assessed. In addition, the health insurance fund launched a pilot project to clarify the difference between outpatient appointment of a clinical nurse specialist and independent appointment of a (general) nurse. However, there is no evidence-based guideline for outpatient appointments for rheumatic patients.ObjectivesThe aim of the development project was to develop the guideline for outpatient appointment of a clinical nurse specialist for rheumatology based on evidence-based literature and expert opinions at the Rheumatology Center of East-Tallinn Central Hospital.MethodsThe development project process took place as a plan-do-study-act cycle, using the method of systematic review of the literature to develop the guideline and the method of written survey to obtain an expert opinion on it. Verbal responses from experts for organizational diagnostics and the guideline feedback was analyzed using content analysis. Quantitative or numerical responses were analyzed using descriptive statistics to calculate the frequency distributions (n and %) for each response.ResultsThe guideline developed as part of the development project supports the implementation of a new clinical nurse specialist care service for rheumatic patients.ConclusionBased on previous research analyzed and surveys conducted by experts at the Rheumatology Center, it can be argued that the clinical nurse specialist service differs significantly from the (general) nurse outpatient appointment and is more responsive to the needs of rheumatic patients. There are potential benefits for the clinical nurse specialist of the outpatient appointment to the organization and to society, as this service increases the level of reliability, efficiency, and availability of all nursing care.References[1]Batšinskaja, D. Developing the guideline for outpatient appointment of a clinical nurse specialist at the East-Tallinn Central Hospital Rheumatology Center. Development project. Tallinn: Tallinn Healthcare College, 2022[2]Schober, M., Lehwaldt, D., Rogers, M., Steinke, M., Turale, S., Pulcini, J., Roussel, J., Stewart, D. (2020). Guidelines on advanced practice nursing ICN APN report https://www.icn.ch/system/files/documents/2020-04/ICN_APN%20Report_EN_WEB.pdfAcknowledgementsThank you experts for their opinion.Disclosure of InterestsNone declared
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Mendly, S., et G. Boutsalis. « AB0882-HPR ANCA-ASSOCIATED VASCULITIS : A CLINICAL PRACTICE ASSESSMENT ». Annals of the Rheumatic Diseases 80, Suppl 1 (19 mai 2021) : 1464.2–1465. http://dx.doi.org/10.1136/annrheumdis-2021-eular.3684.
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Background:AAV (ANCA-associated vasculitis) is a group of progressive, rare, severe autoimmune diseases1,2. AAV can affect blood vessels in different parts of the body resulting in damage to vital organs such as the lungs, kidneys, nervous system, gastrointestinal system, skin, eyes, and heart.2 There are currently no approved therapies for remission-induction in patients with AAV. The current treatment armamentarium for AAV is comprised of various immunosuppressive therapies in combination with steroid treatment. Understanding clinical practice gaps in the management of AAV, can inform development of tools to improve physician practices.Objectives:This medical education activity aims to assess physicians’ knowledge on the various manifestations of antineutrophil cytoplasmic antibody-associated vasculitis (AAV), current guideline-recommended treatment strategies for remission induction in patients with AAV, as well as recent clinical trial data for combination therapies used for remission induction.Methods:A 24-question survey consisting of multiple-choice knowledge and case-based questions was made available to nephrologists and rheumatologists without monetary compensation or charge. The questions were designed to evaluate knowledge regarding the various manifestations of AAV and the results from clinical trials that have compared the efficacy of combination therapies used for remission induction in patients with AAV. As well as application of guideline-recommended therapies and clinical trial data for remission induction in patients with AAV within clinical practice. The survey launched online on a website dedicated to continuous professional development. (www.medscape.org/viewarticle/920320) on July 15, 2020. Data were collected until October 1, 2020.Results:363 nephrologists and 190 rheumatologists completed the survey. Physicians demonstrated gaps in the following areas:TopicIncorrect Responses to Knowledge and Clinical Decision-Making Questions (%)NephrologistsRheumatologistsSystemic diseases associated with AAV59%45%How to confirm diagnosis of AAV42%25%Therapy selection to induce remission that would be consistent with guidelines recommendations71%51%Guideline-recommended therapy for patients that do not respond to the induction regimen32%34%Definition of refractory disease95%94%Most effective maintenance strategy for a patient once remission is achieved80%64%Where would an emerging therapy such as a C5a receptor inhibitor fit into the therapeutic armamentarium of AAV?62%47%What are the guideline-recommended therapies to reduce remission in patients without organ-threatening disease?71%51%Most effective maintenance strategy for a patient once remission is achieved80%64%Guideline-recommendations on length of time to continue maintenance therapy31%35%Conclusion:This educational research on assessment of physicians’ (nephrologists and rheumatologists) clinical practices yielded important insights into clinical gaps related to understanding of the disease pathophysiology and progression of AAV, guideline recommendations on diagnosing and managing AAV with guideline-directed medical therapies (GDMTs), strategies for the management of relapsing and refractory disease in AAV and positioning of emerging therapies in the treatment paradigm.References:[1]www.medscape.org/viewarticle/920320.[2]Hutton HL, et al. Semin Nephrol 2017;37(5):418–35.[3]Al-Hussain T, et al. Adv Anat Pathol 2017;24(4):226–34.Disclosure of Interests:Sarah Mendly Grant/research support from: Supported by an independent educational grant from Vifor Pharma, George Boutsalis Grant/research support from: Supported by an independent educational grant from Vifor Pharma
Thèses sur le sujet "EULAR guideline"
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ZANETTI, ANNA. « The management of patients with rheumatoid arthritis : an overview of obstacles and improvement strategies ». Doctoral thesis, Università degli Studi di Milano-Bicocca, 2022. http://hdl.handle.net/10281/365542.
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L’artirite reumatoide (AR) è la più diffusa patologia autoimmune in Italia con elevati costi terapeutici e previdenziali associati. Questa patologia colpisce circa lo 0.5-1% della popolazione adulta, prevalentemente di genere femminile. Essendo una patologia degenerativa, i cui danni sono frequentemente irreversibili, una diagnosi precoce così come un adeguato trattamento ed un elevato livello di compliance del paziente allo stesso, potrebbero rallentare il peggioramento della malattia. Inoltre sono poco noti i possibili effetti della malattia e del suo trattamento sulle gravidanze e i successivi outcome gravidici. I principali obiettivi della tesi quindi sono: i) valutare l’aderenza alle linee guida per il trattamento dell’ AR da parte dei clinici, ii) valutare l’aderenza al trattamento per AR da parte del paziente, iii) stimare costo ed efficacia delle cure erogate nelle cliniche specializzate per il trattamento di pazienti con AR, iv) analizzare gli esiti gravidici e il raggiungimento della gravidanza in donne con AR trattate con metotrexate (MTX). La prima tematica ha riguardato la valutazione di come sono state implementate le linee guida della European Alliance of Associations for Rheumatology (EULAR) per il trattamento dell’AR e l’impatto dell’aderenza a queste linee guida sulla probabilità di ospedalizzazione. I principali risultati di questo studio hanno mostrato come i pazienti con un’ottima aderenza alle linee guida, se confrontati con quelli con bassa aderenza, abbiano un rischio del 24% inferiore di incorrere in ospedalizzazione. La seconda tematica ha riguardato la valutazione dell’impatto dell’aderenza al trattamento con Disease-Modifying Anti-Rheumatic Drugs (DMARDs), terapia suggerita dall’EULAR, sul raggiungimento della remissione clinica di malattia. I dati provengono dal database ELECTRA (con informazioni cliniche e provenienti da database amministrativi) di pazienti con AR trattati presso l’IRCCS Policlinico San Matteo (Pavia). Si è osservato che un incremento percentuale di 10 unità nella copertura al trattamento comporta un aumento della probabilità di remissione clinica del 10%. Da questi risultati sembra emergere l’importanza di riuscire a monitorare i pazienti nella pratica clinica per mantenere elevati standard di compliance. L’obiettivo della terza tematica si è focalizzato su una valutazione costo-efficacia del trattamento dei pazienti con AR erogato da cliniche specializzate (EAC), confrontandolo con quello dei pazienti trattati in cliniche non specializzate. Sono state quindi reclutate due coorti, la prima di pazienti trattati in una EAC e l’altra estratta dai database amministrativi di regione lombardia tra i soli soggetti con AR. I risultati principali di questa terza fase hanno mostrato come ad un incremento moderato dei costi si associ un incremento molto elevato dell’efficacia, specialmente se calcolata come durata di degenza e come aderenza alle linee guida EULAR. La quarta ed ultima tematica riguarda l’analisi dell’impatto del trattamento con MTX (DMARD suggerito dall’EULAR come prima linea di trattamento) nelle pazienti con AR sulla possibilità di raggiungere una gravidanza e sugli outcome gravidici conseguenti. Sono state definite tre coorti: donne con AR con esposizione incidente di MTX, donne con AR senza trattamento con MTX e donne senza AR. I risultati principali di questa analisi hanno mostrato che le donne con AR, specialmente se trattate con MTX, hanno una minor frequenza di gravidanze rispetto alle donne senza AR. Inoltre, le donne trattate con MTX sembrano avere un rischio più elevato di aborto spontaneo (circa due volte superiore) rispetto alle altre due coorti.Rheumatoid arthritis (RA) is, in Italy, the most widespread autoimmune disease with high associated costs for the National Health Service. This disease affects about 0.5-1% of the adult population, mainly of the female gender. Being a degenerative disease, whose damages are frequently irreversible, an early diagnosis as well as an adequate treatment and a high level treatment compliance of the patient, could slow down the worsening of the disease. Furthermore, the possible effects of RA and its treatment on pregnancies and subsequent pregnancy outcomes are not well known. The main objectives of the thesis are therefore: i) to evaluate the adherence to guidelines for the treatment of RA, ii) to evaluate the patient's adherence to RA treatment, iii) to estimate the cost and effectiveness of care provided in specialized clinics for the treatment of RA patients, iv) to analyze pregnancy outcomes and the likelihood of achieving pregnancy in women with RA treated with methotrexate (MTX). The first issue concerned the assessment of how the guidelines of the European Alliance of Associations for Rheumatology (EULAR) for the treatment of RA have been implemented, and the impact of adherence to these guidelines on the probability of hospitalization. The main results of this study showed that patients with excellent adherence to guidelines, when compared with those with low adherence, have a 24% lower risk of hospitalization. The second topic concerned the evaluation of the impact of adherence to treatment with Disease-Modifying Anti-Rheumatic Drugs (DMARDs), the therapy suggested by EULAR, on the achievement of disease clinical remission (defined as a substantial decrease or absence of symptoms). The ELECTRA database, which contains clinical information and information from administrative databases of RA patients treated at the IRCCS Policlinico San Matteo (Pavia), was considered for the analysis. The main finding showed that a 10-unit percentage increase in proportion of days covered by DMARDs is associated with a 10% increase in the likelihood of clinical remission. These results show the importance of monitoring patients in clinical practice to maintain high levels of treatment compliance. The objective of the third theme focused on a cost-effectiveness evaluation, comparing RA patients treated in specialized clinics ("Early Arthritis Clinic" - EAC), with RA patients treated in non-specialized clinics. Two cohorts were recruited, the first one included patients treated in the EAC of the IRCCS Policlinico San Matteo and the other one with patients with RA extracted from the administrative databases of Lombardy region. The main results of this third phase showed that a moderate increase in costs is associated with a very high increase in effectiveness, especially if calculated as length of hospitalizations and as adherence to the EULAR guidelines. These findings could open up new scenarios in RA patient management. The fourth and final topic concerned the impact of treatment with MTX (DMARD suggested by EULAR as the first line of treatment) in RA women, on the likelihood of achieving pregnancy and on pregnancy outcomes. Three cohorts were recruited: women with RA with incident MTX exposure, women with RA without MTX treatment, and women without RA. The main results of this analysis showed that women with RA, especially when treated with MTX, have a lower frequency of pregnancies than women without RA. Furthermore, women treated with MTX have a higher risk of spontaneous abortion (about twice as high) than the other two cohorts.
Livres sur le sujet "EULAR guideline"
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Xu, Huji, Feng Huang, Chan-Bum Choi et Tae-Hwan Kim. Axial spondyloarthritis in Asia. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198734444.003.0028.
Texte intégralRésumé :
The prevalence of axial spondyloarthritis (axSpA) in Chinese and Korean populations is not dissimilar to that in Caucasians. However, the age of onset is younger and peripheral arthritis of the lower limb is relatively more common. Multicenter studies have revealed similarities and differences among different ethnic backgrounds. For example, the dominant HLA-B27 subtype in Chinese SpA is B2704, while it is B2705 in Koreans. Both Chinese and Korean rheumatologists have adopted ASAS/EULAR guidelines to manage axSpA. TNFi are covered by insurance in Korea but not in China. Owing to early onset and the high cost of TNFi therapy, axSpA has placed enormous burdens on both patients and society in Asia. To achieve a higher HRQoL, rheumatologists are bringing forward cost-effective and treat-to-target therapeutic strategies by integrating nonpharmacological treatment, traditional medications, and biologics in a multimodality setting. Further basic and clinical studies in Asian populations are needed to improve decision-making in clinical practice.
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Dasgupta, Bhaskar. Polymyalgia rheumatica. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199642489.003.0134.
Texte intégralRésumé :
This chapter reviews advances in pathogenesis; European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) classification criteria with clinical, laboratory, and ultrasound criteria for classification as polymyalgia rheumatica (PMR); the heterogeneity and overlap between PMR, inflammatory arthritis, and large-vessel vasculitis as illustrated by representative cases; recent guidelines on early and correct recognition, investigations, and management of PMR; the scope of disease-modifying agents; socio-economic impact, outcomes, and patient experience in PMR. It also discusses areas for future research including clinical trials with biological agents and newer steroid formulations, standardized outcome assessments, and the search for better biomarkers in PMR. PMR is one of the common inflammatory rheumatic diseases of older people and represents a frequent indication for long-term glucocorticoid (GC) therapy. It is characterized by abrupt-onset pain and stiffness of the shoulder and pelvic girdle muscles. Its management is subject to wide variations of clinical practice and it is managed in primary or secondary care by general practitioners (GPs), rheumatologists, and non-rheumatologists. The evaluation of PMR can be challenging, as many clinical and laboratory features may also be present in other conditions, including other rheumatological diseases, infection, and neoplasia. PMR is usually diagnosed in the primary care setting, but standard clinical investigations and referral pathways for suspected PMR are unclear. The response to standardized therapy is heterogeneous, and a significant proportion of patients do not respond completely. There is also an overlap with inflammatory arthritis and large-vessel vasculitis for which adjuvant disease-modifying medications are often used. Prolonged corticosteroid therapy is associated with a variety of side effects, especially when high-dose glucocorticoid therapy is employed. Giant cell arteritis (GCA) is also often linked to PMR. It is a vasculitis of large- and medium-sized vessels causing critical ischaemia. GCA is a medical emergency because of the high incidence of neuro-ophthalmic complications. Both conditions are associated with a systemic inflammatory response and constitutional symptoms. The pathogenesis is unclear. The initiating step may be the recognition of an infectious agent by aberrantly activated dendritic cells. The key cell types involved are CD4+ T cells and macrophages giving rise to key cytokines such as interferon-γ (implicated in granuloma formation), PDGF (intimal hyperplasia), and interleukin (IL)-6 (key to the systemic response). The pathogenesis of PMR may be similar to that of GCA, although PMR exhibits less clinical vascular involvement. The mainstay of therapy is corticosteroids, and disease-modifying therapy is currently indicated in relapsing disease.
Chapitres de livres sur le sujet "EULAR guideline"
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Shiboski, Caroline H., et Troy E. Daniels. « Historical background, classification, and diagnostic criteria ». Dans Oxford Textbook of Sjögren's Syndrome, sous la direction de Elizabeth J. Price et Anwar R. Tappuni, 5–12. Oxford University Press, 2021. http://dx.doi.org/10.1093/med/9780198806684.003.0002.
Texte intégralRésumé :
The objective of this chapter is to describe the evolution of, and critically assess, the various diagnostic and classification criteria for Sjögren’s syndrome (SS) first published in 1965. This chapter provides a historical perspective on the natural history of SS and the various diagnostic tests that have proven useful over time and are individual criteria items within the classification criteria set for SS most recently approved by the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR). We also summarize the guidelines and important steps recommended by the relevant ACR and EULAR committees for the development and validation of criteria for the rheumatic diseases. Finally, we describe the development and validation of the 2016 ACR-EULAR classification criteria for SS as part of a large international collaborative effort.
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Dasgupta, Bhaskar, et Charles Raine. « Polymyalgia rheumatica ». Dans Oxford Textbook of Rheumatology, 1125–31. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199642489.003.0134_update_001.
Texte intégralRésumé :
This chapter reviews advances in pathogenesis; European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) classification criteria with clinical, laboratory, and ultrasound criteria for classification as polymyalgia rheumatica (PMR); the heterogeneity and overlap between PMR, inflammatory arthritis, and large-vessel vasculitis as illustrated by representative cases; pathogenesis; recent guidelines on early and correct recognition, investigations, and management of PMR; the scope of disease-modifying agents; socio-economic impact, outcomes, and patient experience in PMR. It also discusses areas for future research including clinical trials with biological agents and newer steroid formulations, standardized outcome assessments, and the search for better biomarkers in PMR.
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Dasgupta, Bhaskar, et Charles Raine. « Polymyalgia rheumatica ». Dans Oxford Textbook of Rheumatology, 1125–31. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199642489.003.0134_update_002.
Texte intégralRésumé :
This chapter reviews advances in pathogenesis; European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) classification criteria with clinical, laboratory, and ultrasound criteria for classification as polymyalgia rheumatR); the heterogeneity and overlap between PMR, inflammatory arthritis, and large-vessel vasculitis as illustrated by representative cases; pathogenesis; recent guidelines on early and correct recognition, investigations, and management of PMR; the scope of disease-modifying agents; socio-economic impact, outcomes, and patient experience in PMR. It also discusses areas for future research including clinical trials with biological agents and newer steroid formulations, standardized outcome assessments, disease stratification, disease heterogeneity, and the search for better biomarkers in PMR.
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Alenzi, Fahidah, et David P. D’Cruz. « Recent Advances in SLE Treatment Including Biologic Therapies ». Dans Systemic Lupus Erythematosus - Pathogenesis and Management [Working Title]. IntechOpen, 2022. http://dx.doi.org/10.5772/intechopen.105558.
Texte intégralRésumé :
Systemic lupus erythematosus (SLE) is a long-term multisystem autoimmune rheumatic disease that can affect the skin, joints, kidneys, lungs, heart, and central nervous system. Clinical manifestations range from mild to severe and life-threatening diseases, which could be associated with poor outcomes, including morbidity, poor quality of life, and mortality. There is no cure for SLE, and the management is guided by organ system involvement, flare prevention, managing comorbidities, and reducing damage accumulation. Hydroxychloroquine is the most common drug that is used to control lupus disease activity. Anifrolumab is an antibody that inhibits all signaling through the type I interferon receptor and is licensed for the treatment of moderate to severe SLE. Voclosporin is a calcineurin inhibitor approved for the treatment of lupus nephritis. Belimumab as a biologic agent has been approved for the management of individuals with SLE and lupus nephritis. Despite the fact that rituximab has failed to meet its primary endpoints in clinical trials for SLE, rituximab can be used according to ACR and EULAR guidelines and is commonly used off-label for severe lupus flares. There is an unmet need for new biologic and novel therapeutic approaches in the management of SLE.
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Talab, R. S., et Hope R. Botterbusch. « Legal and Ethical Aspects of Teaching in Selected Social Virtual Worlds ». Dans Digital Rights Management, 1395–416. IGI Global, 2013. http://dx.doi.org/10.4018/978-1-4666-2136-7.ch070.
Texte intégralRésumé :
Topics discussed in this chapter include Generations Y and Z and their acceptance of virtual reality, the increase in the number of virtual worlds, gaming virtual worlds, and the social virtual worlds for educators selected for inclusion in this discussion. Open source virtual world platform portability issues are discussed in connection with the acquisition, development, and control of virtual property. The line between “play spaces” and real life is discussed in terms of the application of the “magic circle” test to teaching in virtual worlds with a real-money based virtual currency system, as well as how faculty can reduce student legal and ethical problems. Virtual world law is examined in light of the terms of service (TOS) and end-user license agreements (EULAs), the concept of virtual property, community standards/behavioral guidelines, safety/privacy statements, intellectual property and copyright. Ethical aspects of teaching in virtual worlds include a definition and analysis of griefing/abuse, harassment, false identity, and ways that each world handles these problems. Whyville, SmallWorlds, and Second Life are examined in terms of legal and ethical aspects Research findings and legal and ethical teaching guidelines are presented for those teaching courses using virtual worlds, with special considerations for teaching in Second Life. These topics are for informational purposes, only. Instructors should seek competent legal counsel.
Actes de conférences sur le sujet "EULAR guideline"
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Weijers, J., P. Dessein, D. Galarza-Delgado, M. González-Gay, B. Kuriya, E. Myasoedova, A. Semb, S. Wållberg-Jonsson et P. van Riel. « FRI0625 Different strategies to implement the eular guideline for cardiovascular risk management in daily practice ». Dans Annual European Congress of Rheumatology, EULAR 2018, Amsterdam, 13–16 June 2018. BMJ Publishing Group Ltd and European League Against Rheumatism, 2018. http://dx.doi.org/10.1136/annrheumdis-2018-eular.5216.
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Legault, K., C. Hillis, C. Yeung, A. Iorio, M. Crowther, E. Akl, M. Carrier et al. « THU0561 Clinical practice guideline for diagnosis and management of catastrophic antiphospholipid syndrome ». Dans Annual European Congress of Rheumatology, 14–17 June, 2017. BMJ Publishing Group Ltd and European League Against Rheumatism, 2017. http://dx.doi.org/10.1136/annrheumdis-2017-eular.2085.
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Da Silva, D., E. Rook, N. Semis-Costa, J. Mueller-Berghaus et R. Vesely. « Fri0609 european medicines agency's guideline on the clinical investigation of medicinal products for the treatment of rheumatoid arthritis ». Dans Annual European Congress of Rheumatology, EULAR 2018, Amsterdam, 13–16 June 2018. BMJ Publishing Group Ltd and European League Against Rheumatism, 2018. http://dx.doi.org/10.1136/annrheumdis-2018-eular.6853.
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Farid, Rashid, Leanne Gray, Dean John, Daniel Holehouse et Lesley Ottewell. « SAT0419 HAS THE INTRODUCTION OF A PRIMARY CARE GOUT GUIDELINE RESULTED IN SERUM URIC ACID (SUA) TARGETS BEING ACHIEVED ? » Dans Annual European Congress of Rheumatology, EULAR 2019, Madrid, 12–15 June 2019. BMJ Publishing Group Ltd and European League Against Rheumatism, 2019. http://dx.doi.org/10.1136/annrheumdis-2019-eular.4279.
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Parmar, E., J. Waddell et J. Gardner-Medwin. « AB1092 An audit on paediatric uveitis in the greater glasgow and clyde (GGC) service : guideline adherence and impact on patient outcomes ». Dans Annual European Congress of Rheumatology, EULAR 2018, Amsterdam, 13–16 June 2018. BMJ Publishing Group Ltd and European League Against Rheumatism, 2018. http://dx.doi.org/10.1136/annrheumdis-2018-eular.7266.
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Font, P., MC Castro, M. Romero, R. Ortega, J. Calvo, D. Ruiz, M. Cardenas, R. Alejandre, P. Carreto et E. Collantes. « AB0388 Results at 3 years of an optimization guideline of biological therapies in rheumatoid arthritis. create record results ». Dans Annual European Congress of Rheumatology, 14–17 June, 2017. BMJ Publishing Group Ltd and European League Against Rheumatism, 2017. http://dx.doi.org/10.1136/annrheumdis-2017-eular.2156.
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Bartlett, S. J., O. Schieir, M. F. Valois, B. Haraoui, G. Boire, C. Thorne, C. Hitchon et al. « SAT0112 Guideline-based care improves outcomes that matter to patients : tighter control, less suffering, and greater well-being over the past decade in canadian ra patients ». Dans Annual European Congress of Rheumatology, EULAR 2018, Amsterdam, 13–16 June 2018. BMJ Publishing Group Ltd and European League Against Rheumatism, 2018. http://dx.doi.org/10.1136/annrheumdis-2018-eular.5579.
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Ridge, Lynne. « EUCAR - Automotive LCA Guidelines - Phase 2 ». Dans Total Life Cycle Conference & Exposition. 400 Commonwealth Drive, Warrendale, PA, United States : SAE International, 1998. http://dx.doi.org/10.4271/982185.
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Cervera, Ricard. « SP0201 CATASTROPHIC APS TREATMENT GUIDELINES ». Dans Annual European Congress of Rheumatology, EULAR 2019, Madrid, 12–15 June 2019. BMJ Publishing Group Ltd and European League Against Rheumatism, 2019. http://dx.doi.org/10.1136/annrheumdis-2019-eular.8444.
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Bardin, T. « SP0070 What are gout guidelines good for ? » Dans Annual European Congress of Rheumatology, EULAR 2018, Amsterdam, 13–16 June 2018. BMJ Publishing Group Ltd and European League Against Rheumatism, 2018. http://dx.doi.org/10.1136/annrheumdis-2018-eular.7823.
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