Gaps between research and recommendations in rheumatoid arthritis
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Rheumatology International https://doi.org/10.1007/s00296-020-04724-z
INTERNATIONAL
RECOMMENDATIONS
Gaps between research and recommendations in rheumatoid arthritis Ana María Ortiz1 · Lucía Silva Fernández2 · Virginia Villaverde3 · Miguel Ángel Abad4 · José Ramón Maneiro5 · Gloria Candelas6 · Susana Gómez7 · Mónica Valderrama7 · María Montoro7 Received: 30 July 2020 / Accepted: 6 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Objectives To identify recommendations on the diagnosis and management of rheumatoid arthritis (RA) supported by low recommendation grades, to study the causes of this low grading, and to propose solutions. Methods A group of six rheumatologists, with extensive experience in the development of systematic reviews, reviewed national and international RA recommendations and practice guidelines. They identified all recommendations with a low level of evidence or recommendation grade (levels equivalent to 4, 5, or grades C or D of the Oxford Levels of Evidence), classified them by areas (diagnosis, follow-up, treatment, others), and analyzed plausible causes of low graduation. A Delphi was used to select 10 recommendations where it was most important to obtain quality evidence to support them. Subsequently, actions were proposed to improve evidence and recommendation grading. Results Fourteen documents were analyzed, in which 192 recommendations with low evidence/grade of recommendation were identified, most of which were on treatment. The two most frequent causes of this low level are the absence of studies and the discrepancy between the wording of the recommendation and the evidence used. Finally, the proposed solution to the critical recommendations is a list of unanswered research questions and possible designs to answer them. Conclusions We propose to design and promote research that truly supports or rectifies clinical practice and, thus, bridges the gap between existing evidence and critical recommendations. Keywords Rheumatoid arthritis · Recommendations · Clinical practice guidelines · Level of evidence · Systematic review
1
Lucía Silva Fernández [email protected]
Rheumatology Service, Hospital Universitario de La Princesa, IIS-IP, Calle Diego de León, 62, 28006 Madrid, Spain
2
Virginia Villaverde [email protected]
Rheumatology Service, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain
3
Miguel Ángel Abad [email protected]
Rheumatology Service, Hospital Universitario de Móstoles, Madrid, Spain
4
José Ramón Maneiro [email protected]
Rheumatology Service, Hospital Virgen del Puerto, Plasencia, Cáceres, Spain
5
Gloria Candelas [email protected]
Rheumatology Service, Complexo Hospitalario Universitario de Pontevedra e O Salnés, Pontevedra, Spain
6
Susana Gómez [email protected]
UGC of Rheumatology, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
7
Medical Department, Pfizer, Madrid, Spain
* Ana María Ortiz [email protected]
Mónica Vald
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