The Italian Society of Rheumatology clinical practice guidelines for the management of polymyalgia rheumatica

Abstract

Objective: to provide evidence-based up-to-date recommendations for the management of patients with a definite diagnosis of polymyalgia rheumatica (PMR). Methods: A systematic literature review was performed to find the existing clinical practice guidelines (CPGs) on PMR and the framework of the Guidelines International Network Adaptation Working Group was used to appraise (AGREE II), synthesize, and customize the recommendations according to the needs of the Italian healthcare context. Rheumatologists on behalf of the Italian Society of Rheumatology (SIR) and from the SIR Epidemiology Unit joined the working group and identified the key health questions on PMR to guide the systematic literature review. Physicians, including general practitioners and specialists, and health professionals who manage PMR in the clinical practice were the target audience. The final recommendations were rated externally by a multi-disciplinary and multi-professional group of stakeholders. Results: From the systematic search in databases (Medline, Embase) and grey literature, 3 CPGs were identified and appraised by two independent raters. Combining the statements and the evidence from these CPGs, 9 recommendations were developed by endorsement or adaptation in response to the initial key health questions. The quality of evidence was graded and the working group discussed the final recommendations in view of their implementation in the Italian healthcare context. Conclusions: In absence of national guidelines so far, these recommendations are the first to provide guidance for the management of patients with a diagnosis of PMR in Italy and they are expected to ensure the best evidence-based clinical practice for this disease.

Ревматическая Полимиалгия В Клинических Рекомендациях 2018–2020 Годов. Часть I. Группы Риска, Адъювантная Терапия

“…Taking into account the demographic tendencies and the PMR prevalence in Italy, the above-mentioned 2015-2018 international recommendations being published, the lack of national standards and need for the improved healthcare quality provided to the elderly patients with polymyalgia syndrome [11], the Italian Society of Reumatology (Società Italiana di Reumatologia (SIR)) published its first clinical practice guideline on PMR patient management in 2020. Among its target recipients there were rheumatologists, general practitioners, internists, geriatricians, physical therapists, rehabilitologists "and other healthcare experts in charge of PMR management at the primary care level, in-patient and social care institutions", subjects involved in the policy development and patients; target population being patients aged ≥ 18 years with a physician-diagnosed PMR [30].…”

“…the targeted detection of "the recently occurring headache, sudden vision disorders, jaw pain at mastication, tenderness and reduced temporal artery pulsation" in all the PMR patients [31]. This clause was developed into recommendation for the FDG-PET/CT(A) use as a diagnostic tool able to detect the large vessel vasculitis attending the PMR with a high precision [30].…”

“…much fewer than while developing the 2018 DGRh/ÖGR/SGR guidelines). The sources referred to as "grey" were the repositories of rheumatologic societies "and other information centers" available on the TRIP evidence based medicine (EBM) computed databases and the British National Institute for Health and Care Excellence (NICE), as well as the cross-references and the Google Scholar search results [30]. Most selected documents (13 out of 16) were not considered for the development of the Italian clinical practice guidelines as they turned out as "not being the clinical practice guidelines or consensuses", duplicates, publications in the languages other than English, Italian or German, manuals of a lower standard or inconsistent with the key clinical issues and search timelines.…”

“…The evidence categories (levels) and recommendations (strength) were brought in compliance with the Oxford Centre for Evidence-Based Medicine (CEBM) (Table 1) [34]. The external manual's evaluation and discussion of its implementation in the Italian healthcare system were performed by the multidisciplinary interest group (stakeholders) involving 22 physicians (18 rheumatologists, a general practitioner, an internist, a geriatrist and a rehabilitologist), two experts in healthcare organization and a representative of the patient society [30].…”

“…The finalized 2020 SIR guideline formulations are presented in the Table 2, each of them with the evidence base, recommendation power and stakeholder agreement level attached and ranked as a 10-point scale "as a result of concerted discussion and based on the evidence and clinical experience" [30]. Лекції, огляди / Lectures, Reviews…”