Abstract：
OBJECTIVES:To identify recommendations on the diagnosis and management of rheumatoid arthritis (RA) supported by low recommendation grades, to study the causes of this low grading, and to propose solutions. METHODS:A group of six rheumatologists, with extensive experience in the development of systematic reviews, reviewed national and international RA recommendations and practice guidelines. They identified all recommendations with a low level of evidence or recommendation grade (levels equivalent to 4, 5, or grades C or D of the Oxford Levels of Evidence), classified them by areas (diagnosis, follow-up, treatment, others), and analyzed plausible causes of low graduation. A Delphi was used to select 10 recommendations where it was most important to obtain quality evidence to support them. Subsequently, actions were proposed to improve evidence and recommendation grading. RESULTS:Fourteen documents were analyzed, in which 192 recommendations with low evidence/grade of recommendation were identified, most of which were on treatment. The two most frequent causes of this low level are the absence of studies and the discrepancy between the wording of the recommendation and the evidence used. Finally, the proposed solution to the critical recommendations is a list of unanswered research questions and possible designs to answer them. CONCLUSIONS:We propose to design and promote research that truly supports or rectifies clinical practice and, thus, bridges the gap between existing evidence and critical recommendations.
journal_name
Rheumatol Intjournal_title
Rheumatology internationalauthors
Ortiz AM,Silva Fernández L,Villaverde V,Abad MÁ,Maneiro JR,Candelas G,Gómez S,Valderrama M,Montoro Mdoi
10.1007/s00296-020-04724-zsubject
Has Abstractpub_date
2021-01-01 00:00:00pages
57-66issue
1eissn
0172-8172issn
1437-160Xpii
10.1007/s00296-020-04724-zjournal_volume
41pub_type
杂志文章abstract：:Systemic immune defects might reflect severely dysregulated control of chronic inflammation related to disease progression. Th17/Treg cell imbalance has been demonstrated to be involved in rheumatoid arthritis (RA) pathogenesis. Despite controversial results, a growing anti-inflammatory role in this process has been r...
journal_title：Rheumatology international
pub_type： 杂志文章
doi：10.1007/s00296-013-2895-9
更新日期：2014-02-01 00:00:00
abstract：:The main objective of this study was to assess the symptoms and functional difficulties caused by rheumatoid arthritis through application of the willingness to pay (WTP) method. Structured questionnaire study was conducted among 242 RA patients. The subjects were asked to evaluate their functional capacity using visu...
journal_title：Rheumatology international
pub_type： 杂志文章
doi：10.1007/s00296-009-1280-1
更新日期：2011-03-01 00:00:00
abstract：:We report a case of a 39-year-old female with active systemic lupus erythematosus who complained of lethargy and weakness with a moderate renal impairment. Hypercalcemia was confirmed by laboratory examination. Her X-ray revealed significant ectopic calcinosis in subcutaneous tissue of bilateral hands, and Tc-99(m) me...
journal_title：Rheumatology international
pub_type： 杂志文章,评审
doi：10.1007/s00296-016-3486-3
更新日期：2016-07-01 00:00:00
abstract：:The objective of this study was to compare rheumatoid arthritis (RA) disease activity and patient-reported outcomes (PROs) in a national sample of patients with RA with/without Sjögren's syndrome (SS). Adults with RA from a large observational US registry (Corrona RA) with known SS status between 22 April 2010 and 31 ...
journal_title：Rheumatology international
pub_type： 杂志文章
doi：10.1007/s00296-020-04602-8
更新日期：2020-08-01 00:00:00
abstract：:Leflunomide is a new immunosuppressive medicine that has been effectively used in the therapy of rheumatoid arthritis and subsequently used with success in animal models and patients with systemic lupus erythematosus (SLE). However, its use has also been associated with significant and serious adverse reactions involv...
journal_title：Rheumatology international
pub_type： 杂志文章,评审
doi：10.1007/s00296-012-2508-z
更新日期：2013-02-01 00:00:00
abstract：:The aim of the study was to evaluate the frequency of extra-articular manifestations (EAMs) of rheumatoid arthritis (RA) in a series of patients from nine Italian rheumatology clinics. A total of 587 patients underwent direct questioning, complete physical evaluation, and review of medical records and laboratory data....
journal_title：Rheumatology international
pub_type： 杂志文章
doi：10.1007/pl00006853
更新日期：2000-01-01 00:00:00
abstract：:To investigate the effects of TNF-alpha -308, -238 promoter polymorphisms on TNF-alpha transcription in B27 positive Chinese patients with ankylosing spondylitis (AS). The possible relationship between polymorphisms, MHC antigens, and quantitative TNF-alpha mRNA expression were evaluated. Single nucleotide polymorphis...
journal_title：Rheumatology international
pub_type： 杂志文章
doi：10.1007/s00296-008-0671-z
更新日期：2008-12-01 00:00:00
abstract：:Polyarteritis nodosa (PAN) is a rare systemic vasculitis affecting multiple organs. Current standard treatment includes the use of glucocorticoids and cyclophosphamide. Unfortunately, some patients do not respond to this treatment and other therapeutic options are needed. We present a case of a young male with refract...
journal_title：Rheumatology international
pub_type： 杂志文章,评审
doi：10.1007/s00296-018-4210-2
更新日期：2019-02-01 00:00:00
abstract：:The aims of this systematic review and meta-analysis were to: (1) describe the prevalence of commonly reported comorbidities in psoriatic arthritis (PsA), (2) compare the incidence and/or prevalence of comorbidities between PsA and control populations; and (3) examine the impact of comorbidities on PsA outcomes. We sy...
journal_title：Rheumatology international
pub_type：
doi：10.1007/s00296-020-04775-2
更新日期：2021-02-01 00:00:00
abstract：:P wave dispersion (PWD) is a sign for the prediction of atrial fibrillation (AF). The aim of this study was to assess P wave dispersion and its relation with clinical and echocardiographic parameters in patients with rheumatoid arthritis (RA). Thirty RA patients (mean age 49 +/- 10 years) and 27 healthy controls (mean...
journal_title：Rheumatology international
pub_type： 杂志文章
doi：10.1007/s00296-007-0307-8
更新日期：2007-07-01 00:00:00
abstract：:Several molecular epidemiological studies have been conducted in recent years to evaluate a possible association between the interferon regulatory factor 5 (IRF5) rs2004640 polymorphism and rheumatoid arthritis risk in diverse populations. However, the results remain conflicting rather than conclusive. Our aim was to ...
journal_title：Rheumatology international
pub_type： 杂志文章,meta分析
doi：10.1007/s00296-013-2806-0
更新日期：2013-11-01 00:00:00
abstract：:This retrospective study analyzed the HLA-B 27 alleles in a group of 20 consecutive patients with the diagnosis of Reiter syndrome (RS) followed in a tertiary referral university hospital in Brazil, during the period 1990-2006, and compared the data with that observed in other patients with spondyloarthropathies follo...
journal_title：Rheumatology international
pub_type： 杂志文章
doi：10.1007/s00296-007-0441-3
更新日期：2008-03-01 00:00:00
abstract：:Echocardiographic examination and 24-h electrocardiographic Holter monitoring were carried out on 35 patients with nodular rheumatoid arthritis (RA) and 35 with non-nodular RA, who were matched with the nodular RA group regarding age, sex and BSA. A further 35 patients with osteoarthrosis and spondyloarthrosis matched...
journal_title：Rheumatology international
pub_type： 临床试验,杂志文章
doi：10.1007/s002960050079
更新日期：1999-01-01 00:00:00
abstract：:To compare the effects of treatment with punctal plugs versus artificial tears on visual function for primary Sjögren's syndrome with dry eye. Forty-two eyes of 42 patients with primary Sjögren's syndrome were enrolled and were allocated randomly into artificial tears (AT) group and punctal plugs (PP) group. Ocular Su...
journal_title：Rheumatology international
pub_type： 杂志文章,随机对照试验
doi：10.1007/s00296-013-2769-1
更新日期：2013-10-01 00:00:00
abstract：:Previous studies showed a link between systemic lupus erythematosus (SLE) and Epstein-Barr virus (EBV) infection. We sought to determine the features of serologic response to EBV in SLE patients and whether this response differs from those of systemic sclerosis (SSc) and primary antiphospholipid syndrome (PAPS) patien...
journal_title：Rheumatology international
pub_type： 杂志文章
doi：10.1007/s00296-010-1573-4
更新日期：2012-01-01 00:00:00
abstract：:The assessment of skin fibrosis is vital for the diagnosis and monitoring of treatment in the systemic sclerosis (SSc)-a severe autoimmune disease. The elastography is a technique of skin fibrosis assessment through the evaluation of skin strain. We compared the efficacy of the shear wave elastography (SWE) and common...
journal_title：Rheumatology international
pub_type： 杂志文章
doi：10.1007/s00296-020-04539-y
更新日期：2020-05-01 00:00:00
abstract：:We report a 53-year-old Turkish female presented with progressive weakness and mild dyspnea. Laboratory results demonstrated severe hypokalemia with hyperchloremic metabolic acidosis. The urinary anion gap was positive in the presence of acidemia, thus she was diagnosed with hypokalemic paralysis from a severe distal ...
journal_title：Rheumatology international
pub_type： 杂志文章
doi：10.1007/s00296-011-2322-z
更新日期：2013-07-01 00:00:00
abstract：:We investigated the effect of chrysotherapy on the Fc and complement receptor binding activity of peripheral blood (PB) monocytes and peritoneal (PE) macrophages isolated from normal rats and rats with adjuvant induced arthritis. The adjuvant induced severe disease in Dark Agouti (DA) rats and less marked disease in J...
journal_title：Rheumatology international
pub_type： 杂志文章
doi：10.1007/BF00270454
更新日期：1988-01-01 00:00:00
abstract：:Systemic lupus erythematosus (SLE) is a severe complex rheumatic disease, but good estimate of its prevalence and risk factors is lacking in China. The aim of the study was to explore the prevalence of SLE and risk factors in rural areas of Anhui Province of China. Eleven counties were randomly selected in Anhui Provi...
journal_title：Rheumatology international
pub_type： 杂志文章
doi：10.1007/s00296-013-2902-1
更新日期：2014-03-01 00:00:00
abstract：:Osteomyelitis variolosa is an osteoarticular complication of small pox infection. We are presenting a case of osteomyelitis variolosa, who presented to us with fracture of ankle on the involved side with other orthopedic sequelae of small pox infection, which he contracted during his childhood period. We have discusse...
journal_title：Rheumatology international
pub_type： 杂志文章
doi：10.1007/s00296-011-2194-2
更新日期：2012-11-01 00:00:00
abstract：:Establishing prevention and therapeutic strategies for osteoarthritis (OA) is necessary to minimize functional disability and the impact of the disease on society. The aim of this study was to determine the effects of an exercise therapy protocol on inflammatory markers, perception of pain, and physical performance in...
journal_title：Rheumatology international
pub_type： 杂志文章
doi：10.1007/s00296-014-3148-2
更新日期：2015-03-01 00:00:00
abstract：:There are contradictory results in the relevant literature about the relationship between objective determinants of craniocervical posture and temporomandibular disorder (TMD), whereas no study has worked on ankylosing spondylitis (AS) and TMD relationship. We conducted this study to test the predictors of TMD in AS p...
journal_title：Rheumatology international
pub_type： 杂志文章
doi：10.1007/s00296-020-04563-y
更新日期：2020-06-01 00:00:00
abstract：:Seronegative spondylarthropathies are disorders with the same predisposing antigen, namely HLA B27, a class I molecule of the HLA system. The mechanisms of the different diseases are unknown, and there is no proof of immune system participation. We have investigated patients with spondylarthropathies in order to searc...
journal_title：Rheumatology international
pub_type： 杂志文章
doi：10.1007/BF00390264
更新日期：1994-01-01 00:00:00
abstract：:Ankylosing spondylitis (AS) is an autoimmune spondyloarthropathy involving principally the sacroiliac joint and axial skeleton. Spinal cord involvement is an infrequent and late complication. It mostly results from compressive myelopathy due to skeletal osteopathy and usually presents with radiculomyelopathic sensory ...
journal_title：Rheumatology international
pub_type： 杂志文章
doi：10.1007/s00296-010-1614-z
更新日期：2011-07-01 00:00:00
abstract：:CD28 is one of the main activator receptors involved in systemic lupus erythematosus (SLE) pathogenesis, and its expression and serum levels are significantly higher in patients with SLE and other autoimmune diseases than in healthy controls (HC). However, it is unknown whether this increase is associated with specifi...
journal_title：Rheumatology international
pub_type： 杂志文章
doi：10.1007/s00296-010-1479-1
更新日期：2011-10-01 00:00:00
abstract：:To develop a semi-automated method to quantify inflammation in sacroiliac (SI) joints by measuring bone marrow edema (BME) on MRI. The SCAISS was designed as an image-processing software. Validation followed: (1) three readers evaluated SI images of 23 patients with axial SpA and various levels of BME severity with th...
journal_title：Rheumatology international
pub_type： 杂志文章
doi：10.1007/s00296-018-4104-3
更新日期：2018-10-01 00:00:00
abstract：:The aim of our study was to evaluate effectiveness of ultrasound treatment applied with exercise therapy in patients with ankylosing spondylitis. Fifty-two patients, who were diagnosed according to modified New York criteria, were aged 25-60, and have spine pain, were randomly assigned to two groups. Ultrasound (US) a...
journal_title：Rheumatology international
pub_type： 杂志文章,随机对照试验
doi：10.1007/s00296-016-3441-3
更新日期：2016-05-01 00:00:00
abstract：:Different genetic variants in estrogen receptor alpha (ESR1) have been shown to influence bone phenotypes including quantitative bone ultrasound in elderly. We aimed to investigate the role of ESR1 polymorphisms in bone mass assessed by calcaneal quantitative ultrasound (QUS) in a population of young adults. The study...
journal_title：Rheumatology international
pub_type： 杂志文章
doi：10.1007/s00296-017-3748-8
更新日期：2017-08-01 00:00:00
abstract：:An imbalance in pro- and anti-inflammatory cytokines is suggested to contribute to tissue damage in rheumatoid arthritis (RA). This study was aimed at investigating profiles of cytokines in circulation and cytokines produced by mitogen-stimulated peripheral blood mononuclear cells (PBMC) in RA patients and healthy con...
journal_title：Rheumatology international
pub_type： 杂志文章
doi：10.1007/s00296-017-3774-6
更新日期：2017-10-01 00:00:00
abstract：:Juvenile dermatomyositis (JDM) is a rare but complex and potentially life-threatening autoimmune disease of childhood. Significant proportions of patients have residual weakness, muscle atrophy, joint contractures, and calcinosis. Recently, new clinical findings, such as lipodystrophy accompanied with increased fat de...
journal_title：Rheumatology international
pub_type： 杂志文章
doi：10.1007/s00296-014-3031-1
更新日期：2014-11-01 00:00:00
