Strength of recommendations
| Intervention | Research evidence* | SOR based on efficacy (A–D) | SOR based on all evidence and clinical expertise NRS, mean (SEM) | ||
|---|---|---|---|---|---|
| Efficacy | Side effects | Cost effectiveness | |||
| *Evidence was categorised according to the hierarchy in table 1. –, not supportive; +, supportive. ±, uncertain. Example, Ia + (GI) means there is category Ia evidence to support the statement that the treatment causes GI side effects. | |||||
| SOR, strength of recommendation; NRS, numeric rating scale (0–10, 0 = not recommended at all, 10 = fully recommended); GI, gastrointestinal; ANA, antinuclear antibodies; –, not available; N/A, not applicable. | |||||
| Physiotherapy | Ib + | – | – | A | 7.95 (0.37) |
| Exercise | IIa + | – | – | B | 8.86 (0.27) |
| Education | – | – | – | N/A | 8.18 (0.38) |
| Cognitive therapy | – | – | – | N/A | 4.77 (0.58) |
| NSAIDs | Ib + | Ia + (GI) | N/A | A | 9.14 (0.24) |
| Coxibs | Ib + | Ia − (GI) | Higher GI risk population | A | 7.82 (0.38) |
| Misoprostol | Ia + (GI protection) | Ia + (diarrhoea) | Higher GI risk population | A | 5.55 (0.55) |
| H2 Blockers (double dose) | Ia + (GI protection) | – | High GI risk population | A | 5.73 (0.46) |
| Proton pump inhibitors | Ia + (GI protection) | – | – | A | 7.14 (0.39) |
| Sulfasalazine | Ia ± | Ib + (haematological, mucocutaneous, GI) | – | A | 6.11 (0.72) |
| Methotrexate | Ib − | Ib + (nausea, hepatic) | – | A | 3.14 (0.46) |
| Ciclosporin | IV + | – | – | D | 1.48 (0.38) |
| Azathioprine | IV + | – | – | D | 1.33 (0.33) |
| Hydroxychloroquine | – | – | – | N/A | 0.86 (0.30) |
| Auranofin | III − | – | – | C | 0.57 (0.24) |
| Cyclophosphamide | IV + | – | – | D | 0.86 (0.26) |
| Leflunomide | Ib − | – | – | A | 2.19 (0.39) |
| d-Penicillamine | Ib − | – | – | A | 0.90 (0.33) |
| Pamidronate | III + | III + (acute phase reaction) | – | C | 4.29 (0.38) |
| Thalidomide | III + | III + (neurological) | – | C | 3.48 (0.39) |
| Methylprednisolone (IV) | IV + | – | – | D | 3.90 (0.45) |
| Infliximab | Ib + | Ib + (ANA formation) | Cost effective | A | 9.48 (0.20) |
| Etanercept | Ib + | Ib + (injection site reactions) | Cost effective | A | 9.48 (0.20) |
| Adalimumab | III + | – | – | C | 7.24 (0.56) |
| Anakinra | III ± | – | – | C | 3.14 (0.53) |
| Total hip replacement | IV + | – | – | D | 9.05 (0.28) |
| Spinal surgery | IV + | – | – | D | 7.23 (0.35) |