Elsevier

Joint Bone Spine

Volume 72, Issue 3, May 2005, Pages 222-228
Joint Bone Spine

Original article
Physical examination and laboratory tests in the management of patients with rheumatoid arthritis: development of recommendations for clinical practice based on published evidence and expert opinion

https://doi.org/10.1016/j.jbspin.2004.10.010Get rights and content

Abstract

Objectives. – To develop recommendations for the physical and laboratory-test follow-up of patients with rheumatoid arthritis (RA) seen in everyday practice, using evidence from the literature, supplemented with expert opinion when needed.

Methods. – A scientific committee selected 7–10 questions using the Delphi consensus procedure. Evidence-based responses to each question were sought in the literature and were then used by a panel to develop recommendations. To fill in gaps in knowledge from the literature, the panelists relied on their personal opinion.

Results. – The seven questions dealt with the physical and laboratory-test follow-up of RA and the factors predicting disease severity. The literature review identified 799 articles whose title and abstract suggested relevance to the study. Elimination of articles that provided no data on the study topic left 128 original articles. The panel developed seven recommendations, one for each question, which were accepted by consensus.

Conclusion. – Recommendations about the physical and laboratory-test follow-up of patients with RA seen in everyday practice were developed. Because they constitute an objective foundation built by consensus among experts, should improve the uniformity and quality of care provided to RA patients in everyday practice.

Introduction

Recent improvements in the prognosis of rheumatoid arthritis (RA) can be ascribed not only to therapeutic advances, but also to better standardization of the management of the disease [1]. Uniformity of the tools used to evaluate disease activity is among the factors that contributes to standardized care [2], [3], [4], [5], [6]. Nevertheless, no gold standard is available for evaluating disease activity in patients with RA, and a plethora of tools is used to evaluate treatment responses in clinical trials and everyday practice [6], [7], [8], [9]. Although well validated and widely used in clinical research, these tools are not always suited to everyday rheumatological practice. Epidemiological studies identify pathophysiology-related risk factors at the level of a population but, again, their methodology is ill-suited to everyday practice.

The objective of this study was to have rheumatologists develop evidence-based recommendations designed to standardize the management of RA patients in everyday rheumatological practice. We elected to focus on three areas: the physical and laboratory-test follow-up of RA patients, the evaluation of structural damage [10], and patient education [11]. The present article reports the results pertaining to the first of these three areas.

Section snippets

Methods

Fig. 1 summarizes the steps involved in the development of the recommendations. A scientific committee of teaching-hospital rheumatologists (BC, RMF, GG, PG, XLL, XM, XP, JS, TS, JS, DW, and MD) carried out the first step, a literature review task force (BF, LG, and TP) the second step, and a panel of experts the third step.

Literature review

The literature review identified 78,191 articles on RA, of which 9476 provided data on the physical and/or laboratory-test follow-up of patients with RA. Selection on the title then the abstract left 799 articles. Articles that provided no information on physical and/or laboratory-test follow-up were eliminated. This left 128 original articles, of which none were randomized controlled trials or metaanalyses of physical or laboratory-test criteria for monitoring RA patients in everyday practice.

Discussion

The objective of this study was to find answers to unresolved questions relevant to the everyday management of patients with RA [10], [11]. The recent introduction of new drugs and therefore of new treatment strategies has radically changed the management of RA [52]. Clearly, this new situation requires new recommendations to help French rheumatologists in their everyday practice.

The recommendations described here are mainly evidence-based. However, because large gaps in knowledge still exist,

Acknowledgments

This study was supported by Abbott France.

We are grateful to Catherine Mazzacco, Hubert Drougard, and Gérard Goldfarb from Laboratoires Abbott France for their support and to the 77 experts who gave of their knowledge and experience to participate in developing these recommendations (names listed in [11]).

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