Gossec Laure, Pavy Stephan, Pham Thao, Constantin Arnaud, Poiraudeau Serge, Combe Bernard, Flipo René-Marc, Goupille Philippe, Le Loët Xavier, Mariette Xavier, Puéchal Xavier, Wendling Daniel, Schaeverbeke Thierry, Sibilia Jean, Tebib Jacques, Cantagrel Alain, Dougados Maxime
Service de rhumatologie B, CHU de Cochin, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France.
Joint Bone Spine. 2006 Jul;73(4):396-402. doi: 10.1016/j.jbspin.2006.01.008. Epub 2006 Mar 20.
To develop clinical practice guidelines for the use of nonpharmacological treatments in patients with early rheumatoid arthritis (RA), using the evidence-based approach and expert opinion.
A scientific committee used a Delphi prioritization procedure to select five questions. Evidence providing answers to the five questions was sought in the literature and presented to a panel of rheumatologists. The panel developed five detailed recommendations, filling gaps in evidence with their expert opinion. The strength of each recommendation was determined.
Of the 565 publications retrieved by the literature review, 198 were included in the analysis. The five recommendations on nonpharmacological treatments for early RA were validated by a final vote among all participants. The recommendations are as follows: (1) physicians may decide to provide joint protection education to patients with potentially severe early RA, with the knowledge that structured joint protection programs have not been found effective; (2) physical exercise and sports can be recommended to patients with early RA; muscle strength exercises are advisable; (3) in patients with early RA, metatarsal pain and/or foot alignment abnormalities should be looked for regularly, and appropriate insoles should be prescribed if needed; (4) dietary measures and nutritional supplements are not indicated as part of the treatment of early RA; (5) elimination diets, particularly those with low intakes of dairy products, should be discouraged in patients with early RA.
These recommendations should help to improve practice uniformity and, ultimately, to improve the management of RA.
采用循证方法并结合专家意见，制定早期类风湿关节炎（RA）患者非药物治疗的临床实践指南。
一个科学委员会采用德尔菲优先排序程序选择了五个问题。在文献中寻找能回答这五个问题的证据，并提交给一组风湿病学家。该小组制定了五项详细建议，用他们的专家意见填补证据空白。确定了每项建议的力度。
通过文献综述检索到565篇出版物，其中198篇纳入分析。关于早期RA非药物治疗的五项建议经所有参与者的最终投票得到验证。建议如下：（1）医生可以决定为潜在严重早期RA患者提供关节保护教育，但要知道尚未发现结构化关节保护方案有效；（2）可以向早期RA患者推荐体育锻炼和运动；建议进行肌肉力量锻炼；（3）对于早期RA患者，应定期检查是否有跖骨疼痛和/或足部排列异常，必要时应开具合适的鞋垫；（4）饮食措施和营养补充剂不作为早期RA治疗的一部分；（５）应劝阻早期RA患者采用排除饮食，尤其是那些低乳制品摄入的饮食。
这些建议应有助于提高实践的一致性，并最终改善RA的管理。
