Using systematic literature reviews to develop guidelines for the management of inflammatory arthritis

Abstract

The vast amount of research published on clinical areas can make awareness of current data difficult. Systematic literature reviews (SLR) are performed in order to identify, appraise and summarise the available evidence relating to specific clinical questions, and form the basis of the process used to produce clinical guidelines.

This thesis describes the different processes used to produce guidelines using SLR. It includes a review of the literature on imaging in the management of rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA) as examples.

To perform the RA review, key clinical questions were generated on the role of imaging in RA, which included the use of conventional radiography (CR),ultrasound (US), magnetic resonance imaging (MRI), computed tomography (CT),dual-emission X-ray absorptiometry (DXA), digital X-ray radiogrammetry (DXR), scintigraphy and positron emission tomography (PET). A comprehensive SLR was then performed resulting in recommendations on the role of imaging in making a diagnosis of RA, detecting inflammation and damage, predicting outcome and response to treatment, monitoring disease activity, progression and remission. A similar process was used to produce recommendations in the management of JIA;however the lack of quality data meant that ‘points to consider’ were created.

The thesis also considers the quality of existing recommendations with potential areas for improvement discussed. It concludes with a discussion of the overall benefit of guidelines.

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Identifiers

ORCID for Cyrus Cooper: orcid.org/0000-0003-3510-0709

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