title: The process of collecting and evaluating evidences for the development of Guidelines for the management of rheumatoid arthritis, Japan College of Rheumatology 2014: Utilization of GRADE approach.
abstract: OBJECTIVE
  To describe the process of collecting and evaluating evidence for treating rheumatoid arthritis (RA) for developing clinical practice guidelines (CPGs) for rheumatologists in Japan.
  
  
  METHODS
  The task force comprised rheumatologists, epidemiologists, health economists, and patients. First, the critical outcomes were determined according to a three-round Delphi method, and eight topics with 88 clinical questions (CQs) were formulated. A systematic review of CQs was conducted using the Cochran Database of Systematic Reviews, MEDLINE, and Japana Centra Revvo Medicina (2003-2012). A questionnaire survey and focus group interview were performed to capture the patients' values and preferences. Data from the National Health Insurance drug price list and product information provided by pharmaceutical companies were collected to evaluate drug cost and safety. The GRADE approach was used to describe the evidence quality and determine the strength of recommendations. Recommendations were developed using a modified Delphi method by a multidisciplinary panel including patients.
  
  
  RESULTS
  Eight meetings and frequent e-mail communications were conducted to draft a quality assessment of evidence and recommendations. For 88 CQs, recommendation statements were determined.
  
  
  CONCLUSIONS
  Using the GRADE approach, new CPGs successfully addressed important clinical issues for treating RA patients. Timely updating of recommendations should be routinely considered.
authors.affiliation: a Department of Public Health , Nagoya City University Graduate School of Medical Sciences , Nagoya , Japan.
authors.forename: Masayo
authors.initials: M
authors.lastname: Kojima
authors.affiliation: b Department of Health Informatics , Kyoto University School of Public Health , Kyoto , Japan.
authors.forename: Takeo
authors.initials: T
authors.lastname: Nakayama
authors.affiliation: c Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine , Kyoto , Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Kawahito
authors.affiliation: d Division of Rheumatology, Department of Internal Medicine , Keio University School of Medicine , Tokyo , Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kaneko
authors.affiliation: e Division of Allergy and Rheumatology, St Luke's International Hospital , Tokyo , Japan.
authors.forename: Mitsumasa
authors.initials: M
authors.lastname: Kishimoto
authors.affiliation: f The First Department of Internal Medicine , School of Medicine, University of Occupational and Environmental Health , Japan, Kitakyushu , Japan.
authors.forename: Shintaro
authors.initials: S
authors.lastname: Hirata
authors.affiliation: g Institute of Rheumatology, Tokyo Women's Medical University , Tokyo , Japan.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Seto
authors.affiliation: h Division of Rheumatology, Department of Internal Medicine , School of Medicine, Toho University Tokyo , Japan.
authors.forename: Hirahito
authors.initials: H
authors.lastname: Endo
authors.affiliation: i Department of Orthopaedic Surgery , Kyoto University Graduate School of Medicine , Kyoto , Japan.
authors.forename: Hiromu
authors.initials: H
authors.lastname: Ito
authors.affiliation: j Department of Orthopedic Surgery , Nagoya University Hospital , Nagoya , Japan.
authors.forename: Toshihisa
authors.initials: T
authors.lastname: Kojima
authors.affiliation: k Department of Human Morphology , Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences , Okayama , Japan.
authors.forename: Keiichiro
authors.initials: K
authors.lastname: Nishida
authors.affiliation: l Department of Orthopaedic Surgery , Faculty of Medicine, University of Toyama , Toyama , Japan.
authors.forename: Isao
authors.initials: I
authors.lastname: Matsushita
authors.affiliation: m Department of Drug Policy and Management , Graduate School of Pharmaceutical Sciences, The University of Tokyo , Tokyo , Japan.
authors.forename: Kiichiro
authors.initials: K
authors.lastname: Tsutani
authors.affiliation: m Department of Drug Policy and Management , Graduate School of Pharmaceutical Sciences, The University of Tokyo , Tokyo , Japan.
authors.forename: Ataru
authors.initials: A
authors.lastname: Igarashi
authors.affiliation: g Institute of Rheumatology, Tokyo Women's Medical University , Tokyo , Japan.
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Kamatani
authors.affiliation: n The Japan Rheumatism Friendship Association , Japan.
authors.forename: Mieko
authors.initials: M
authors.lastname: Hasegawa
authors.affiliation: o Tokyo Medical and Dental University , Tokyo , Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Miyasaka
authors.affiliation: g Institute of Rheumatology, Tokyo Women's Medical University , Tokyo , Japan.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Yamanaka
mesh_terms: D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D003697:Delphi Technique; D019468:Disease Management; D019317:Evidence-Based Medicine / Q000592:standards*; D006801:Humans; D007564:Japan; D017410:Practice Guidelines as Topic / Q000592:standards*; D012219:Rheumatology / Q000592:standards*
keywords: Clinical practice guidelines; GRADE; Rheumatoid arthritis; Systematic review