The Canadian Rheumatology Association/ Spondyloarthritis Research Consortium of Canada treatment recommendations for the management of spondyloarthritis: a national multidisciplinary stakeholder project.
OBJECTIVE
Development of treatment recommendations for arthritis has traditionally relied on the compilation of evidence-based data by experts in the field despite recommendations by various bodies for broad stakeholder input. Our objectives were: (1) To develop evidence-based treatment recommendations for the management of spondyloarthritis (SpA) in Canada that also incorporate the perspective of multiple stakeholders. (2) To generate a procedural template for the multidisciplinary development of treatment recommendations.


METHODS
The process was directed by a steering committee comprising the SPARCC Executive, rheumatologists from academic and community-based practice, patient consumers, and a representative from the John Dossetor Health Ethics Centre. Guidelines established by EULAR and stipulated in the AGREE instrument were followed. First, a working document was drafted that included a referenced summary of the evidence-based data and the 12 national arthritis care standards developed by the Alliance for the Canadian Arthritis Program. Second, a Web-based survey was conducted among patient consumers to address the relevance to patients of 2 primary outcome instruments that assess the effectiveness of treatment. Third, a list of questions was generated for drafting propositions by the ethics consultant. A Delphi consensus exercise was then conducted.


RESULTS
Consensus was generated on a final list of 38 treatment recommendations categorized under the subject headings of general management principles, ethical considerations, target groups, definition of target disease, disease monitoring, and specific management recommendations.


CONCLUSIONS
Using broad stakeholder input, we provide treatment recommendations to guide clinical practice and access to care for patients with SpA in Canada.
Maksymowych
Walter P
WP
University of Alberta, Edmonton, Alberta, Canada.
Gladman
Dafna
D
Rahman
Proton
P
Boonen
Annelies
A
Bykerk
Vivien
V
Choquette
Denis
D
Dimond
Sherry
S
Fortin
Paul
P
Karsh
Jacob
J
Klinkhoff
Alice V
AV
Mosher
Dianne
D
Mulholland
Ken
K
Olszynski
Wojciech P
WP
Russell
Anthony S
AS
Savage
Laurie
L
Shanner
Laura
L
Shojania
Kam
K
Starr
Michael
M
Thomson
Glen
G
Zummer
Michel
M
Inman
Robert
R
D002170:Canada; D004992:Ethics, Medical; D019317:Evidence-Based Medicine; D006801:Humans; D012955:Societies, Medical; D025242:Spondylarthropathies / Q000628:therapy*