Sidiropoulos P I, Hatemi G, Song I-H, Avouac J, Collantes E, Hamuryudan V, Herold M, Kvien T K, Mielants H, Mendoza J M, Olivieri I, Østergaard M, Schachna L, Sieper J, Boumpas D T, Dougados M
Department of Internal Medicine, Division of Rheumatology, Clinical Immunology and Allergy, University of Crete, Medical School, Voutes 71500, Heraklion, Greece.
Rheumatology (Oxford). 2008 Mar;47(3):355-61. doi: 10.1093/rheumatology/kem348.
Recommendations and/or guidelines represent a popular way of integrating evidence-based medicine into clinical practice. The 3E Initiatives is a multi-national effort to develop recommendations for the management of rheumatic diseases, which involves a large number of experts combined with practising rheumatologists addressing specific questions relevant to clinical practice.
Ten countries participated in three rounds of discussions and votes concerning the management of AS. A set of nine questions was formulated in the domains of diagnosis, monitoring and treatment, after a Delphi procedure. A literature search in MedLine was conducted. Predefined outcome parameters for the domains of diagnosis, monitoring and treatment were assessed. The evidence to support each proposition was evaluated and scored. After discussion and votes, the final recommendations were presented using brief statements by each national group, following which the final international recommendations were formulated.
A total of 2699 papers were found and 467 were selected for analysis. Twelve key recommendations were developed: three in the domain of diagnosis addressing general diagnostic considerations, early AS diagnosis and general practitioners' referral recommendations; three concerning monitoring of AS disease activity, severity and prognosis; six concerning pharmacological treatment (except biologics): non-steroidal anti-inflammatory drugs/COX-II inhibitors, bisphosphonates and treatment of enthesitis. The compiled agreement among experts ranged from 72% to 93%.
Recommendations for the management of AS were developed using an evidence-based approach followed by expert/physician consensus with high level of agreement. Involvement of a larger and more representative group of rheumatologists may improve their dissemination and implementation in daily clinical practice.
推荐意见和/或指南是将循证医学融入临床实践的一种常用方式。3E倡议是一项多国合作项目，旨在制定风湿性疾病管理的推荐意见，该项目汇聚了众多专家以及执业风湿病学家，共同探讨与临床实践相关的具体问题。
十个国家参与了关于强直性脊柱炎（AS）管理的三轮讨论和投票。经过德尔菲法程序后，在诊断、监测和治疗领域拟定了一组九个问题。对MedLine进行了文献检索。评估了诊断、监测和治疗领域预先设定的结果参数。对支持每个提议的证据进行了评估和评分。经过讨论和投票后，每个国家小组以简短声明的形式提出了最终推荐意见，随后制定了最终的国际推荐意见。
共检索到2699篇论文，其中467篇被选作分析之用。制定了十二条关键推荐意见：诊断领域三条，涉及一般诊断考量、AS早期诊断以及全科医生转诊建议；AS疾病活动、严重程度和预后监测方面三条；药物治疗（生物制剂除外）方面六条：非甾体抗炎药/环氧化酶-2抑制剂、双膦酸盐以及附着点炎的治疗。专家之间达成的综合共识率在72%至93%之间。
采用循证方法并经专家/医生达成高度共识，制定了AS管理的推荐意见。纳入规模更大、更具代表性的风湿病学家群体，可能会提高这些推荐意见在日常临床实践中的传播和实施效果。
