欧洲抗风湿病联盟关于风湿性疾病全身糖皮质激素治疗管理的循证推荐意见。
EULAR evidence-based recommendations on the management of systemic glucocorticoid therapy in rheumatic diseases.
作者信息
Hoes J N, Jacobs J W G, Boers M, Boumpas D, Buttgereit F, Caeyers N, Choy E H, Cutolo M, Da Silva J A P, Esselens G, Guillevin L, Hafstrom I, Kirwan J R, Rovensky J, Russell A, Saag K G, Svensson B, Westhovens R, Zeidler H, Bijlsma J W J
机构信息
Department of Rheumatology & Clinical Immunology (F02.127), University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
出版信息
Ann Rheum Dis. 2007 Dec;66(12):1560-7. doi: 10.1136/ard.2007.072157. Epub 2007 Jul 27.
OBJECTIVE
To develop evidence-based recommendations for the management of systemic glucocorticoid (GC) therapy in rheumatic diseases.
METHODS
The multidisciplinary guideline development group from 11 European countries, Canada and the USA consisted of 15 rheumatologists, 1 internist, 1 rheumatologist-epidemiologist, 1 health professional, 1 patient and 1 research fellow. The Delphi method was used to agree on 10 key propositions related to the safe use of GCs. A systematic literature search of PUBMED, EMBASE, CINAHL, and Cochrane Library was then used to identify the best available research evidence to support each of the 10 propositions. The strength of recommendation was given according to research evidence, clinical expertise and perceived patient preference.
RESULTS
The 10 propositions were generated through three Delphi rounds and included patient education, risk factors, adverse effects, concomitant therapy (ie, non-steroidal anti-inflammatory drugs, gastroprotection and cyclo-oxygenase-2 selective inhibitors, calcium and vitamin D, bisphosphonates) and special safety advice (ie, adrenal insufficiency, pregnancy, growth impairment).
CONCLUSION
Ten key recommendations for the management of systemic GC-therapy were formulated using a combination of systematically retrieved research evidence and expert consensus. There are areas of importance that have little evidence (ie, dosing and tapering strategies, timing, risk factors and monitoring for adverse effects, perioperative GC-replacement) and need further research; therefore also a research agenda was composed.
目的
制定关于风湿性疾病全身糖皮质激素（GC）治疗管理的循证建议。
方法
来自11个欧洲国家、加拿大和美国的多学科指南制定小组由15名风湿病学家、1名内科医生、1名风湿性疾病流行病学家、1名卫生专业人员、1名患者和1名研究员组成。采用德尔菲法就与GC安全使用相关的10项关键提议达成共识。随后，对PubMed、EMBASE、CINAHL和Cochrane图书馆进行系统文献检索，以确定支持这10项提议中每一项的最佳现有研究证据。根据研究证据、临床专业知识和患者偏好给出推荐强度。
结果
通过三轮德尔菲法得出了10项提议，包括患者教育、风险因素、不良反应、联合治疗（即非甾体抗炎药、胃保护和环氧化酶-2选择性抑制剂、钙和维生素D、双膦酸盐）以及特殊安全建议（即肾上腺功能不全、妊娠、生长发育受损）。
结论
结合系统检索的研究证据和专家共识，制定了关于全身GC治疗管理的10项关键建议。存在一些重要领域证据不足（即给药和减量策略、时机、风险因素和不良反应监测、围手术期GC替代），需要进一步研究；因此还制定了一项研究议程。
Zotero 插件