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A ustralian and N ew Z ealand national evidence‐based recommendations for the investigation and follow‐up of undifferentiated peripheral inflammatory arthritis: an integration of systematic literature research and rheumatological expert opinion
Author(s) -
Barrett Claire,
Bird Paul,
Major Gabor,
Romas Evange,
Portek Ian,
Taylor Andrew,
Zochling Jane
Publication year - 2013
Publication title -
international journal of rheumatic diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.795
H-Index - 41
eISSN - 1756-185X
pISSN - 1756-1841
DOI - 10.1111/1756-185x.12189
Subject(s) - medicine , systematic review , evidence based medicine , delphi method , alternative medicine , medline , family medicine , expert opinion , evidence based practice , pathology , intensive care medicine , statistics , mathematics , political science , law
Aim To develop A ustralian and N ew Z ealand ( ANZ ) recommendations for the investigation and follow‐up of undifferentiated peripheral inflammatory arthritis ( UPIA ) using an evidence‐based approach. Methods Ten questions pertaining to the investigation and follow‐up of patients with UPIA in daily rheumatological practice were defined by clinicians using a modified D elphi approach. A systematic literature search was conducted for each of the final questions. The results were presented to a workshop of 54 ANZ rheumatologists in M ay 2009. Discussions were held to develop consensus statements for each question, based on published evidence and clinical experience/expertise. Results Ten recommendations were made on diagnostic value of clinical features in the patient's history and examination, predictors of poor prognosis and persistence, synovial fluid analysis, serology, imaging and human leukocyte antigen B 27 testing. The lack of specific research to inform recommendations presented a challenge. Dynamic discussion groups outlined individual experience in areas without good quality clinical trial evidence. The median strength of support for the final set of recommendations was 7/10 (interquartile range 6–8), ranging from 6 to 9 for individual statements. Conclusion Ten ANZ recommendations for the investigation and follow‐up of UPIA were formulated, based on available evidence and extensive clinical experience. The systematic literature review was of limited value while animated discussion of individual experience, with subsequent information exchange, highlighted the importance of merging clinical expertise with published literature to establish practical recommendations that can improve quality of care in rheumatology.