D' Angelo S, Padula A, Nigro A, Cantini F, Matucci-Cerinic M, Modena V, Punzi L, Salvarani C, Scarpa R, Olivieri I
Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza. Italy.
Clin Exp Rheumatol. 2008 Nov-Dec;26(6):1005-11.
The 3E (Evidence, Expertise, Exchange) Initiative is a multinational effort of rheumatologists aimed at developing evidence-based recommendations addressing specific questions relevant to clinical practice. The objective of the Italian part of the 3E Initiative was to develop new recommendations designed to help Italian rheumatologists in everyday clinical practice management of patients suffering from ankylosing spondylitis (AS).
An international scientific committee selected a set of questions concerning the diagnosis, monitoring, and treatment of AS using a Delphi procedure. Evidence-based answers to each question were sought by a systematic literature search in MedLine for papers published up to August 2006. A panel of 55 Italian rheumatologists with expertise in the field of AS used the evidence thus gathered to develop recommendations, filling gaps in evidence with their expert opinion.
After discussion and votes, the panel developed 12 statements/recommendations: 3 concerning diagnosis (low back pain approach, early diagnosis, and GPs referral recommendations); 3 concerning monitoring (disease activity, severity, and prognosis), and 6 concerning treatment (bisphosphonates role; treatment of enthesitis; inter-agent safety/efficacy, long-term safety/efficacy, efficacy on different disease manifestations, and the role on inflammatory bowel disease flare precipitation of NSAIDs/COX-II inhibitors).
Italian recommendations for the management of AS in everyday practice were developed. Their dissemination and implementation in daily clinical practice should help to improve practice uniformity and eventually optimize the management of AS patients.
3E（证据、专业知识、交流）倡议是风湿病学家的一项跨国行动，旨在针对与临床实践相关的特定问题制定基于证据的建议。3E倡议意大利部分的目标是制定新的建议，以帮助意大利风湿病学家在日常临床实践中管理强直性脊柱炎（AS）患者。
一个国际科学委员会采用德尔菲法选定了一组有关AS诊断、监测和治疗的问题。通过在MedLine中系统检索截至2006年8月发表的论文，为每个问题寻求基于证据的答案。一个由55名在AS领域具有专业知识的意大利风湿病学家组成的小组利用收集到的证据制定建议，并用他们的专家意见填补证据空白。
经过讨论和投票，该小组制定了12项声明/建议：3项关于诊断（下背痛处理、早期诊断以及全科医生转诊建议）；3项关于监测（疾病活动度、严重程度和预后）；6项关于治疗（双膦酸盐的作用；附着点炎的治疗；药物间安全性/疗效、长期安全性/疗效、对不同疾病表现的疗效以及非甾体抗炎药/环氧化酶-2抑制剂对炎症性肠病发作的影响）。
制定了意大利在日常实践中管理AS的建议。在日常临床实践中传播和实施这些建议应有助于提高实践的一致性，并最终优化AS患者的管理。
