title: Using a modified Delphi process to establish clinical consensus for the diagnosis, risk assessment and abatacept treatment in patients with aggressive rheumatoid arthritis.
abstract: OBJECTIVE
  We aimed to formulate consensus statements for the identification of patients with rheumatoid arthritis (RA) who may benefit most from abatacept treatment, in order to clear up points related to its use in rheumatology.
  
  
  METHODS
  Two rounds of a modified Delphi process were conducted. In the first round, a board of experts defined a list of consensus statements based on data derived from a non-systematic review on the use of abatacept in adult RA patients. In the second round, clinicians with extensive experience in the treatment of RA were invited to express individually agreement on the statements, using a dedicated online platform. A face-to-face meeting of the board was held after round two. Consensus was defined as 75% agreement.
  
  
  RESULTS
  In Delphi process round one, a board of 10 experts defined a list of 20 consensus statements on abatacept treatment. Then, a panel of 37 rheumatologists participated in round two. The majority of clinicians (75.7%) had 10 or more years of experience in the treatment of RA patients. Fifteen of the 20 statements reached the defined level of consensus.
  
  
  CONCLUSIONS
  Identified consensus statements may help clinicians to apply to routine-care settings results from clinical studies and clinical recommendations, providing a guide for the initiation of abatacept treatment in RA patients.
authors.affiliation: Rheumatology, University of Pavia, IRCCS Policlinico S. Matteo, Pavia, Italy. roberto.caporali@unipv.it.
authors.forename: Roberto
authors.initials: R
authors.lastname: Caporali
authors.affiliation: Rheumatology Unit, University of Verona, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Carletto
authors.affiliation: Rheumatology, Department of Internal Medicine, University "La Sapienza", Rome, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Conti
authors.affiliation: Rheumatology Department, S. Carlo Hospital, Potenza, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: D'Angelo
authors.affiliation: Rheumatology Unit, Vittorio Emanuele Hospital, Catania, Italy.
authors.forename: Rosario
authors.initials: R
authors.lastname: Foti
authors.affiliation: Rheumatology Unit, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Gremese
authors.affiliation: Rheumatology Department, S. Anna University, Ferrara, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Govoni
authors.affiliation: Rheumatology, University of Bari, Italy.
authors.forename: Florenzo
authors.initials: F
authors.lastname: Iannone
authors.affiliation: Rheumatology Unit, Ospedale Mauriziano, Turin, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Pellerito
authors.affiliation: Rheumatology Department, University of Milan, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Sinigaglia
mesh_terms: D000069594:Abatacept / Q000009:adverse effects / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D000066491:Clinical Decision-Making; D032921:Consensus; D003697:Delphi Technique; D019317:Evidence-Based Medicine; D006801:Humans; D018579:Patient Selection; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D000069594:Abatacept