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      Brazilian recommendations for the use of nonsteroidal anti-inflammatory drugs in patients with axial spondyloarthritis

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      , , , , , , , , , , , , , , , , , , , , , , , , , , ,
      Advances in Rheumatology
      Sociedade Brasileira de Reumatologia
      Spondyloarthritis, Ankylosing spondylitis, Nonsteroidal anti-inflammatory drugs, Systematic review, Meta-analysis, Guidelines

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          Abstract

          Abstract Spondyloarthritis (SpA) is a group of chronic inflammatory systemic diseases characterized by axial and/or peripheral joints inflammation, as well as extra-articular manifestations. Over some decades, nonsteroidal anti-inflammatory drugs (NSAIDs) have been the basis for the pharmacological treatment of patients with axial spondyloarthritis (axSpA). However, the emergence of the immunobiologic agents brought up the discussion about the role of NSAIDs in the management of these patients. The objective of this guideline is to provide recommendations for the use of NSAIDs for the treatment of axSpA. A panel of experts from the Brazilian Society of Rheumatology conducted a systematic review and meta-analysis of randomized clinical trials for 15 predefined questions. The Grading of Recommendations, Assessment, Development and Evaluation methodology to assess the quality of evidence and formulate recommendations were used, and at least 70% agreement of the voting panel was needed. Fourteen recommendations for the use of NSAIDs in the treatment of patients with axSpA were elaborated. The purpose of these recommendations is to support clinicians’ decision making, without taking out his/her autonomy when prescribing for an individual patient.

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          Most cited references116

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          GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables.

          This article is the first of a series providing guidance for use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system of rating quality of evidence and grading strength of recommendations in systematic reviews, health technology assessments (HTAs), and clinical practice guidelines addressing alternative management options. The GRADE process begins with asking an explicit question, including specification of all important outcomes. After the evidence is collected and summarized, GRADE provides explicit criteria for rating the quality of evidence that include study design, risk of bias, imprecision, inconsistency, indirectness, and magnitude of effect. Recommendations are characterized as strong or weak (alternative terms conditional or discretionary) according to the quality of the supporting evidence and the balance between desirable and undesirable consequences of the alternative management options. GRADE suggests summarizing evidence in succinct, transparent, and informative summary of findings tables that show the quality of evidence and the magnitude of relative and absolute effects for each important outcome and/or as evidence profiles that provide, in addition, detailed information about the reason for the quality of evidence rating. Subsequent articles in this series will address GRADE's approach to formulating questions, assessing quality of evidence, and developing recommendations. Copyright © 2011 Elsevier Inc. All rights reserved.
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            The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection.

            To validate and refine two sets of candidate criteria for the classification/diagnosis of axial spondyloarthritis (SpA). All Assessment of SpondyloArthritis international Society (ASAS) members were invited to include consecutively new patients with chronic (> or =3 months) back pain of unknown origin that began before 45 years of age. The candidate criteria were first tested in the entire cohort of 649 patients from 25 centres, and then refined in a random selection of 40% of cases and thereafter validated in the remaining 60%. Upon diagnostic work-up, axial SpA was diagnosed in 60.2% of the cohort. Of these, 70% did not fulfil modified New York criteria and, therefore, were classified as having "non-radiographic" axial SpA. Refinement of the candidate criteria resulted in new ASAS classification criteria that are defined as: the presence of sacroiliitis by radiography or by magnetic resonance imaging (MRI) plus at least one SpA feature ("imaging arm") or the presence of HLA-B27 plus at least two SpA features ("clinical arm"). The sensitivity and specificity of the entire set of the new criteria were 82.9% and 84.4%, and for the imaging arm alone 66.2% and 97.3%, respectively. The specificity of the new criteria was much better than that of the European Spondylarthropathy Study Group criteria modified for MRI (sensitivity 85.1%, specificity 65.1%) and slightly better than that of the modified Amor criteria (sensitivity 82.9, specificity 77.5%). The new ASAS classification criteria for axial SpA can reliably classify patients for clinical studies and may help rheumatologists in clinical practice in diagnosing axial SpA in those with chronic back pain. NCT00328068.
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              Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria.

              The New York and the Rome diagnostic criteria for ankylosing spondylitis (AS) and the clinical history screening test for AS were evaluated in relatives of AS patients and in population control subjects. The New York criterion of pain in the (dorso) lumbar spine lacks specificity, and the chest expansion criterion is too insensitive. The Rome criterion of low back pain for more than 3 months is very useful. Our study showed the clinical history screening test for AS to be moderately sensitive, but it might be better in clinical practice. As a modification of the New York criteria, substitution of the Rome pain criterion for the New York pain criterion is proposed.
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                Author and article information

                Journal
                adr
                Advances in Rheumatology
                Adv. rheumatol.
                Sociedade Brasileira de Reumatologia (São Paulo, SP, Brazil )
                2523-3106
                2021
                : 61
                : 4
                Affiliations
                [4] Porto Alegre Rio Grande do Sul orgnameUniversidade Federal do Rio Grande do Sul Brazil
                [13] Campinas São Paulo orgnameUniversidade Estadual de Campinas Brazil
                [5] São Paulo São Paulo orgnameUniversidade de São Paulo Brazil
                [18] Brasília Distrito Federal orgnameUniversidade de Brasília Brazil
                [9] Sorocaba SP orgnamePontifícia Universidade Católica (PUC) de Sorocaba Brazil
                [12] São Paulo SP orgnameHospital Heliópolis Brazil
                [14] Ribeirão Preto orgnameRibeirão Preto Brazil
                [2] Recife Pernambuco orgnameUniversidade Federal de Pernambuco Brazil
                [7] Rio de Janeiro RJ orgnameSanta Casa de Misericórdia (SCM) do Rio de Janeiro Brazil
                [11] Campinas São Paulo orgnamePontifícia Universidade Católica de Campinas Brazil
                [1] Belo Horizonte Minas Gerais orgnameUniversidade Federal de Minas Gerais Brazil
                [15] São Paulo São Paulo orgnameInstituto de Assistência Médica ao Servidor Público Estadual Brazil
                [16] Rio de Janeiro Rio de Janeiro orgnameUniversidade Federal do Rio de Janeiro Brazil
                [3] São Paulo orgnameUniversidade Federal de São Paulo Brazil
                [8] Porto Alegre RS orgnamePontifícia Universidade Católica (PUC) de Porto Alegre Brazil
                [6] Goiânia orgnameHospital Estadual Geral de Goiania Brazil
                [10] São Paulo SP orgnameSanta Casa de Misericórdia (SCM) de São Paulo Brazil
                [17] Curitiba Paraná orgnameUniversidade Federal do Paraná Brazil
                Article
                S2523-31062021000100301 S2523-3106(21)06100000301
                10.1186/s42358-020-00160-6
                a6997675-f5d7-4af8-9cae-67596d011d1a

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 03 July 2020
                : 29 December 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 116, Pages: 0
                Product

                SciELO Brazil

                Self URI: Full text available only in PDF format (EN)
                Categories
                Position Article and Guidelines

                Spondyloarthritis,Ankylosing spondylitis,Nonsteroidal anti-inflammatory drugs,Systematic review,Meta-analysis,Guidelines

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