Raptopoulou A, Sidiropoulos P, Siakka P, Boki K, Drosos A A, Aslanidis S, Karras D, Pikazis D, Vassilopoulos D, Karassa F, Boumpas D T
Department of Internal Medicine, Division of Rheumatology, Clinical Immunology and Allergy, University of Crete, Medical School, Heraklion, Greece.
Clin Exp Rheumatol. 2008 Sep-Oct;26(5):784-92.
The 3E (Evidence, Experts and Exchange) Initiative is a multi-national effort that involves a large number of experts and practicing rheumatologists addressing specific questions relevant to everyday clinical practice, concerning the management of Ankylosing Spondylitis. Within this multinational group, the Hellenic working group, addressed specific issues complementary to the international ones, and formulated evidence-based recommendations, in order to improve everyday clinical practice for patients with Ankylosing Spondylitis.
A scientific committee of rheumatologists specializing in AS formulated a set of 7 questions in three domains: diagnosis, monitoring and treatment. Literature search in MedLine for papers published up to August 2006 was conducted. The evidence to support each proposition was evaluated and scored. To avoid any conflict of interest with the sponsor issues related to the use of biologics were not discussed. After extensive discussion among 50 rheumatologists and one Delphi round of votes, the final recommendations were formulated.
A literature search resulted in a total of 320 relevant papers of which 29 were evaluated. A total of seven recommendations were formulated: two concerning diagnosis (role of HLA-B27 and MRI) and prognosis, one concerning monitoring for extra-articular manifestations and four concerning treatment (analgesics, disease modifying agents and physical therapy) were made. The level of evidence and the strength of recommendation were reported. The compiled agreement among experts ranged from 90% up to 100%.
Recommendations for the management of AS were developed using an evidence-based approach followed by physicians' consensus with high level of agreement. These are complementary to existing ones, and address specific domains of everyday clinical practice.
3E（证据、专家与交流）倡议是一项多国合作项目，涉及众多专家和执业风湿病学家，旨在解决与强直性脊柱炎日常临床管理相关的特定问题。在这个多国团队中，希腊工作组探讨了与国际问题互补的特定议题，并制定了基于证据的建议，以改善强直性脊柱炎患者的日常临床实践。
一个由专门研究强直性脊柱炎的风湿病学家组成的科学委员会在三个领域提出了一组7个问题：诊断、监测和治疗。对截至2006年8月发表在MedLine上的论文进行了文献检索。对支持每个提议的证据进行了评估和评分。为避免与赞助商存在利益冲突，未讨论与生物制剂使用相关的问题。在50名风湿病学家进行广泛讨论并经过一轮德尔菲投票后，制定了最终建议。
文献检索共得到320篇相关论文，其中29篇被评估。共制定了七条建议：两条关于诊断（HLA - B27和MRI的作用）和预后，一条关于关节外表现的监测，四条关于治疗（镇痛药、改善病情药物和物理治疗）。报告了证据水平和推荐强度。专家之间的综合共识率从90%到100%不等。
采用基于证据的方法并经医生高度一致的共识制定了强直性脊柱炎管理的建议。这些建议是对现有建议的补充，并涉及日常临床实践的特定领域。
