加拿大风湿病学会关于系统性红斑狼疮评估和监测的建议。
Canadian Rheumatology Association Recommendations for the Assessment and Monitoring of Systemic Lupus Erythematosus.
机构信息
From the Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Canadian Arthritis Patient Alliance; Division of Rheumatology, Department of Medicine, McGill University; Division of Rheumatology, Department of Medicine, Université de Montréal, Montreal; Division of Rheumatology, Department of Medicine, Université Laval, Quebec City, Quebec; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto; Division of Rheumatology, Department of Medicine, McMaster University, Hamilton, Ontario; Division of Rheumatology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia; Division of Rheumatology, Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario; Division of Rheumatology, Department of Medicine, University of Manitoba, Winnipeg, Manitoba; General Internal Medicine, McGill University Health Centre, McGill University, Montreal, Quebec; Cochrane Musculoskeletal Group, University of Ottawa, Ottawa; Division of Rheumatology, Department of Medicine, Western University, London, Ontario; Canadian Agency for Drugs and Technologies in Health, Ottawa; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton; Centre for Practice-changing Research, Ottawa Hospital Research Institute, Ottawa, Ontario.
S.O. Keeling, MD, MSc, FRCP(C), Division of Rheumatology, Department of Medicine, University of Alberta; Z. Alabdurubalnabi, MBBS, ABIM, FRCPC, Division of Rheumatology, Department of Medicine, University of British Columbia; A. Avina-Zubieta, MD, MSc, PhD, FRCPC, Division of Rheumatology, Department of Medicine, University of British Columbia; S. Barr, MD, MSc, FRCPC, Associate Professor, University of Calgary; S. Bernatsky, MD, PhD, FRCPC, Professor of Medicine, McGill University; J. Bourre-Tessier, MD, MSc, FRCPC, Associate Clinical Professor, Université de Montréal; A. Clarke, MD, MSc, FRCPC, Professor of Medicine, Cumming School of Medicine, University of Calgary; A. Baril-Dionne, MD, Internal Medicine Resident, Université de Montréal; J. Dutz, MD, FRCPC, Professor of Medicine, University of British Columbia; S. Ensworth, MD FRCPC, Clinical Assistant Professor, University of British Columbia; A. Fifi-Mah, MD, FRCPC, Clinical Assistant Professor, University of Calgary; P.R. Fortin, MD, FRCPC, Professor of Medicine, Université Laval; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto; D. Haaland, MD, MSc, FRCPC, Assistant Clinical Professor, McMaster University; J.G. Hanly, MD, FRCPC, Professor of Medicine, Dalhousie University; L.T. Hiraki, MD, FRCPC, ScD, Assistant Professor, University of Toronto; S. Hussein, MD, Internal Medicine Resident, Université de Montréal; K. Legault, MD, MSc, FRCPC, Assistant Professor, McMaster University; D. Levy, MD, MSc, FRCPC, Associate Professor, University of Toronto; L. Lim, MBBS, MRCPCH, FRCPC, PhD, Assistant Professor, University of Manitoba; M. Matsos, MD, FRCPC, Associate Professor, McMaster University; E.G. McDonald, MD, FRCPC, Assistant Professor, McGill University; J. Pardo Pardi, Co-Managing Editor, Cochrane Musculoskeletal Group, Centre for Practice-changing Research, Ottawa Hospital Research Institute; C. Peschken, MD, FRCPC, Associate Professor, University of Manitoba; C. Pineau, MD, FRPCP, Associate Professor, McGill University; J. Pope, MD, FRCP(C), Professor of Medicine, Western University; T. Rader, MLIS, Canadian Agency for Drugs and Technologies in Health; J. Reynolds, MD, FRCPC, Clinical Assistant Professor, University of British Columbia; E. Silverman, MD, FRCPC, Professor of Pediatrics, University of Toronto; K. Tselios, MD, PhD, Clinical Research Fellow, University of Toronto; M. Suitner, MD, Internal Medicine Resident, Université de Montréal; M. Urowitz, MD, FRCPC, Professor of Medicine, University of Toronto; Z. Touma, MD, PhD, Assistant Professor, University of Toronto; E. Vinet, MD, PhD, Assistant Professor, McGill University; N. Santesso, RD, PhD, Assistant Professor, McMaster University. Louise Bergeron and Dr. Jorge Medina-Rosas died before the manuscript was completed.
出版信息
J Rheumatol. 2018 Oct;45(10):1426-1439. doi: 10.3899/jrheum.171459. Epub 2018 Sep 1.
OBJECTIVE
To develop recommendations for the assessment of people with systemic lupus erythematosus (SLE) in Canada.
METHODS
Recommendations were developed using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. The Canadian SLE Working Group (panel of Canadian rheumatologists and a patient representative from Canadian Arthritis Patient Alliance) was created. Questions for recommendation development were identified based on the results of a previous survey of SLE practice patterns of members of the Canadian Rheumatology Association. Systematic literature reviews of randomized trials and observational studies were conducted. Evidence to Decision tables were prepared and presented to the panel at 2 face-to-face meetings and online.
RESULTS
There are 15 recommendations for assessing and monitoring SLE, with varying applicability to adult and pediatric patients. Three recommendations focus on diagnosis, disease activity, and damage assessment, suggesting the use of a validated disease activity score per visit and annual damage score. Strong recommendations were made for cardiovascular risk assessment and measuring anti-Ro and anti-La antibodies in the peripartum period and conditional recommendations for osteoporosis and osteonecrosis. Two conditional recommendations were made for peripartum assessments, 1 for cervical cancer screening and 2 for hepatitis B and C screening. A strong recommendation was made for annual influenza vaccination.
CONCLUSION
These are considered the first guidelines using the GRADE method for the monitoring of SLE. Existing evidence is largely of low to moderate quality, resulting in more conditional than strong recommendations. Additional rigorous studies and special attention to pediatric SLE populations and patient preferences are needed.
目的
制定加拿大评估系统性红斑狼疮（SLE）患者的建议。
方法
采用 GRADE（推荐分级的评估、制定与评价）方法制定建议。成立了加拿大 SLE 工作组（由加拿大风湿病学家和加拿大关节炎患者联盟的一名患者代表组成的小组）。根据加拿大风湿病学会成员 SLE 实践模式的先前调查结果确定了制定建议的问题。对随机试验和观察性研究进行了系统文献综述。准备了证据决策表，并在 2 次面对面会议和在线会议上提交给专家组。
结果
共有 15 项关于评估和监测 SLE 的建议，对成人和儿科患者的适用性不同。有 3 项建议侧重于诊断、疾病活动度和损伤评估，建议在每次就诊和每年评估时使用经过验证的疾病活动评分和损伤评分。强烈建议进行心血管风险评估，并在围产期测量抗 Ro 和抗 La 抗体。强烈建议骨质疏松症和骨坏死筛查，有条件建议进行围产期评估，有条件建议进行宫颈癌筛查和乙型肝炎和丙型肝炎筛查。强烈建议每年接种流感疫苗。
结论
这些是使用 GRADE 方法监测 SLE 的首批指南。现有证据主要质量为低到中等，导致条件性建议多于强烈建议。需要进行更多严格的研究，并特别关注儿科 SLE 人群和患者偏好。
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