Recomendações portuguesas «como diagnosticar, monitorizar e tratar a artrite periférica indiferenciada»: Revisão sistematizada da literatura e opinião de peritos

Translated title of the contribution: Portuguese recommendations on how to diagnose, monitor and treat undifferentiated peripheral inflammatory arthritis: A systematic literature review and experts' opinions

Ana Ribeiro, Pedro Machado, Sofia Ramiro, Cátia Duarte, Ana Filipa Mourão, Mónica Bogas, Maria Lúcia Costa, Miguel Bernardes, Maria José Santos, João Eurico Fonseca, José António Pereira da Silva, Helena Canhão, Ana Teixeira, Ana Cordeiro, Ana Rodrigues, Anabela Cardoso, António P Alves de Matos, Augusto Faustino, Catarina Ambrósio, Cândida SilvaCarlos Vaz, Catarina Resende, Cristina Ponte, Dina Medeiros, Domingos Araújo, Fátima Godinho, Fernando Alvarenga, Filipe Barcelos, Jaime Branco, João Madruga Dias, Maria João Ramos, João Rovisco, Jorge Silva, Jorge Garcia, José Alberto Pereira Da Silva, José António Melo Gomes, José Costa, José Canas da Silva, José Redondo, Luís Maurício Santos, Margarida Coutinho, Margarida Cruz, Margarida Oliveira, Cristina Catita, Graça Sequeira, Inês Cunha, Maria João Saavedra, Maria Júlia Ferreira, Manuela Fernandes, Paula Araújo, Patrícia Nero, Paula Valente, Pedro Abreu, Raquel Roque, Ricardo Figueira, Rui André Santos, Sandra Falcão, Patrícia Pinto, Sandra Garcês, Sara Cortes, Sara Serra, Taciana Videira, Viviana Tavares

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Abstract

Objective: The 3E (Evidence, Expertise, Exchange) Initiative is a multinational effort of rheumatologists aimed at developing evidence-based recommendations addressing specific questions relevant to clinical practice. The objective of the Portuguese contribution for the 3E Initiative was to develop evidence-based recommendations on how to investigate, follow-up and treat undifferentiated peripheral inflammatory arthritis (UPIA) adapted to local reality and develop additional recommendations considered relevant in the national context. Methods: An international scientific committee from 17 countries selected a set of questions concerning the diagnosis and monitoring of UPIA using a Delphi procedure. Evidence-based answers to each question were sought by a systematic literature search, performed in Medline, Embase, the Cochrane Library and ACR/EULAR 2007-2009 meeting abstracts. Relevant articles were reviewed for quality assessment, data extraction and synthesis. In a national meeting, a panel of 63 Portuguese rheumatologists used the evidence which was gathered to develop recommendations, and filled the gaps in the evidence with their expert opinion. Finally, national recommendations were formulated and agreement among the participants was assessed. Results: A total of 54754 references were identified, of which 267 were systematically reviewed. Thirteen national key recommendations about the investigation, follow-up and treatment of UPIA were formulated. One recommendation addressed differential diagnosis and investigations prior to the established operational diagnosis of UPIA, eight recommendations were related to the diagnostic and prognostic value of clinical and laboratory assessments in established UPIA (history and physical examination, acute phase reactants, serologies, autoantibodies, radiographs, magnetic resonance imaging and ultrasound, genetic markers and synovial biopsy), one recommendation highlighted predictors of persistence (chronicity), one addressed monitoring of clinical disease activity in UPIA, one aimed to find an useful method/score to predict a definitive diagnosis and the last one was related to treatment. Conclusion: Portuguese evidence-based recommendations for the management of UPIA in everyday practice were developed. Their dissemination and implementation in daily clinical practice should help to improve practice uniformity and optimize the management of UPIA patients.

Translated title of the contributionPortuguese recommendations on how to diagnose, monitor and treat undifferentiated peripheral inflammatory arthritis: A systematic literature review and experts' opinions
Original languagePortuguese
Pages (from-to)475-496
Number of pages22
JournalActa reumatologica portuguesa
Volume35
Issue number4
Publication statusPublished - Oct 2010

Keywords

  • Diagnosis
  • Prognosis
  • Recommendations
  • Systematic review
  • Undifferentiated arthritis

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