scholarly journals 2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis

2018 ◽  
Vol 77 (9) ◽  
pp. 1251-1260 ◽  
Author(s):  
Anne-Kathrin Rausch Osthoff ◽  
Karin Niedermann ◽  
Jürgen Braun ◽  
Jo Adams ◽  
Nina Brodin ◽  
...  
Keyword(s):  
Physical Activity ◽  
Inflammatory Arthritis ◽  
Musculoskeletal Diseases ◽  
Task Force ◽  
The Public ◽  
Knee Oa ◽  
Eular Recommendations ◽  
Patient Representatives ◽  
Research And Education ◽  
Level Of Agreement

Regular physical activity (PA) is increasingly promoted for people with rheumatic and musculoskeletal diseases as well as the general population. We evaluated if the public health recommendations for PA are applicable for people with inflammatory arthritis (iA; Rheumatoid Arthritis and Spondyloarthritis) and osteoarthritis (hip/knee OA) in order to develop evidence-based recommendations for advice and guidance on PA in clinical practice. The EULAR standardised operating procedures for the development of recommendations were followed. A task force (TF) (including rheumatologists, other medical specialists and physicians, health professionals, patient-representatives, methodologists) from 16 countries met twice. In the first TF meeting, 13 research questions to support a systematic literature review (SLR) were identified and defined. In the second meeting, the SLR evidence was presented and discussed before the recommendations, research agenda and education agenda were formulated. The TF developed and agreed on four overarching principles and 10 recommendations for PA in people with iA and OA. The mean level of agreement between the TF members ranged between 9.8 and 8.8. Given the evidence for its effectiveness, feasibility and safety, PA is advocated as integral part of standard care throughout the course of these diseases. Finally, the TF agreed on related research and education agendas. Evidence and expert opinion inform these recommendations to provide guidance in the development, conduct and evaluation of PA-interventions and promotion in people with iA and OA. It is advised that these recommendations should be implemented considering individual needs and national health systems.

scholarly journals 2018 update of the EULAR recommendations for the role of the nurse in the management of chronic inflammatory arthritis

2019 ◽  
Vol 79 (1) ◽  
pp. 61-68 ◽  
Author(s):  
Bianca Bech ◽  
Jette Primdahl ◽  
Astrid van Tubergen ◽  
Marieke Voshaar ◽  
Heidi A Zangi ◽  
...  
Keyword(s):  
Inflammatory Arthritis ◽  
Psychosocial Support ◽  
Task Force ◽  
Healthcare Team ◽  
Evidence Based ◽  
Level Of Evidence ◽  
Chronic Inflammatory Arthritis ◽  
Eular Recommendations ◽  
Level Of Agreement

To update the European League Against Rheumatism (EULAR) recommendations for the role of the nurse in the management of chronic inflammatory arthritis (CIA) using the most up to date evidence. The EULAR standardised operating procedures were followed. A task force of rheumatologists, health professionals and patients, representing 17 European countries updated the recommendations, based on a systematic literature review and expert consensus. Higher level of evidence and new insights into nursing care for patients with CIA were added to the recommendation. Level of agreement was obtained by email voting. The search identified 2609 records, of which 51 (41 papers, 10 abstracts), mostly on rheumatoid arthritis, were included. Based on consensus, the task force formulated three overarching principles and eight recommendations. One recommendation remained unchanged, six were reworded, two were merged and one was reformulated as an overarching principle. Two additional overarching principles were formulated. The overarching principles emphasise the nurse’s role as part of a healthcare team, describe the importance of providing evidence-based care and endorse shared decision-making in the nursing consultation with the patient. The recommendations cover the contribution of rheumatology nursing in needs-based patient education, satisfaction with care, timely access to care, disease management, efficiency of care, psychosocial support and the promotion of self-management. The level of agreement among task force members was high (mean 9.7, range 9.6-10.0). The updated recommendations encompass three overarching principles and eight evidence-based and expert opinion-based recommendations for the role of the nurse in the management of CIA.

scholarly journals PARE0013 ‘FIND A NUDGE’ AND OTHER TIPS TO MAINTAIN YOUR LEVEL OF PHYSICAL ACTIVITY FOR A LONGER TIME

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1292.1-1293
Author(s):  
R. Geenen
Keyword(s):  
Physical Activity ◽  
Inflammatory Arthritis ◽  
Sleep Problems ◽  
Musculoskeletal Diseases ◽  
Action Plan ◽  
Well Being ◽  
Physical Activities ◽  
Daily Routine ◽  
Cross Sectional ◽  
Eular Recommendations

Background:Pain, fatigue, physical disability, reduced well-being and sleep problems are common consequences of Rheumatic and Musculoskeletal Diseases (RMDs). Paradoxically, these consequences may all lead to a reduction of physical activity, while physical activity actually is an antidote against these consequences. This is acknowledged by experts that included physical activity and exercise into recommendations for management of RMDs [1-3]. Indeed, after programs aimed at a gradual build-up of exercise, many people with a RMD showed an increase of physical activity. However, it is hard to maintain a higher level of physical activity for years as part of daily routine [4-5].Objectives:To identify and present tips, applications and illustrations that support people with an RMD to maintain their level of physical activity for a longer time.Methods:Theoretical considerations and empirical findings guided the identification of tips. Care was taken that the tips and illustrations were translated into layman language and fitted in daily life of common people.Results:Ten tips were found:1) break the habit,2) make sure you can do the exercise activity,3) use aids if needed,4) believe in a good outcome,5) choose a physical activity that fulfils personal goals,6) find a physical activity that you enjoy,7) stop moving while it’s still fun,8) find a buddy,9) make an action plan, and10) find a nudge.A “nudge” is a little push in the right direction that makes a person unconsciously perform physical activities. Examples are an outdoor photography hobby, a dog that comes to you with a dog leash in his mouth, or grandchildren that persuade you to go with them to the playground nearby. If a person with a RMD manages to find a nudge that stimulates instinctive moving without feeling the effort, then physical activity may be maintained. People differ a lot and must discover for themselves which tips help them to maintain physical activity. They must be aware that it may take up to two months for changed habits to stick.Conclusion:The presented tips will help to maintain your level of physical activity. Nevertheless, be aware that effort and perseverance are needed to keep on moving. A challenge for the future is to get more knowledge of natural and pleasurable physical activities. Peers with successful experiences and behavior change experts can help. For the time being, a main advice to maintain a higher level of physical activity with less effort is to find your own nudges.References:[1]Geenen R, Overman CL, Christensen R, et al. EULAR recommendations for the health professional’s approach to pain management in inflammatory arthritis and osteoarthritis. Ann Rheum Dis 2018;77(6):797–807.[2]Macfarlane GJ, Kronisch C, Dean LE, et al. EULAR revised recommendations for the management of fibromyalgia. Ann Rheum Dis 2017;76(2):318–328.[3]Rausch Osthoff AK, Niedermann K, Braun J, et al. 2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis. Ann Rheum Dis 2018;77(9):1251–1260.[4]Knittle K, Nurmi J, Crutzen R, Hankonen N, Beattie M, Dombrowski SU. How can interventions increase motivation for physical activity? A systematic review and meta-analysis. Health Psychol Rev 2018;12(3):211–230.[5]Demmelmaier I, Bergman P, Nordgren B, Jensen I, Opava CH. Current and maintained health-enhancing physical activity in rheumatoid arthritis: a cross-sectional study. Arthritis Care Res (Hoboken). 2013;65(7):1166–1176.Disclosure of Interests:Rinie Geenen Speakers bureau: Sanofi Genzyme paid for a lecture on depression in RA.

scholarly journals 2020 EULAR points to consider for the prevention, screening, assessment and management of non-adherence to treatment in people with rheumatic and musculoskeletal diseases for use in clinical practice

2020 ◽  
pp. annrheumdis-2020-218986
Author(s):  
Valentin Ritschl ◽  
Tanja A Stamm ◽  
Daniel Aletaha ◽  
Johannes W J Bijlsma ◽  
Peter Böhm ◽  
...  
Keyword(s):  
Musculoskeletal Diseases ◽  
Task Force ◽  
Treatment Plan ◽  
Healthcare Providers ◽  
Structural Barriers ◽  
Adherence To Treatment ◽  
Patient Representatives ◽  
Screening Assessment ◽  
Free Environment ◽  
Level Of Agreement

BackgroundNon-adherence to treatment could preclude reaching an optimal outcome. Thirty to 80% of patients with rheumatic and musculoskeletal diseases (RMDs) do not adhere to the agreed treatment.ObjectivesThe objective was to establish points to consider (PtCs) for the prevention, screening, assessment and management of non-adherence to (non-)pharmacological treatments in people with RMDs.MethodsAn EULAR task force (TF) was established, and the EULAR standardised operating procedures for the development of PtCs were followed. The TF included healthcare providers (HCPs), comprising rheumatologists, nurses, pharmacists, psychologists, physiotherapists, occupational therapists and patient-representatives from 12 European countries. A review of systematic reviews was conducted in advance to support the TF in formulating the PtCs. The level of agreement among the TF was established by anonymous online voting.ResultsFour overarching principles and nine PtCs were formulated. The PtCs reflect the phases of action on non-adherence. HCPs should assess and discuss adherence with patients on a regular basis and support patients to treatment adherence. As adherence is an agreed behaviour, the treatment has to be tailored to the patients’ needs. The level of agreement ranged from 9.5 to 9.9 out of 10.ConclusionsThese PtCs can help HCPs to support people with RMDs to be more adherent to the agreed treatment plan. The basic scheme being prevent non-adherence by bonding with the patient and building trust, overcoming structural barriers, assessing in a blame-free environment and tailoring the solution to the problem.

scholarly journals EULAR points to consider for the development, evaluation and implementation of mobile health applications aiding self-management in people living with rheumatic and musculoskeletal diseases

RMD Open ◽  
2019 ◽  
Vol 5 (2) ◽  
pp. e001014 ◽  
Author(s):  
Aurélie Najm ◽  
Elena Nikiphorou ◽  
Marie Kostine ◽  
Christophe Richez ◽  
John D Pauling ◽  
...  
Keyword(s):  
Mobile Health ◽  
Online Survey ◽  
Musculoskeletal Diseases ◽  
Task Force ◽  
Cost Benefit ◽  
Self Management ◽  
Mobile Health Applications ◽  
Development Evaluation ◽  
Level Of Agreement ◽  
Health Applications

BackgroundMobile health applications (apps) are available to enable people with rheumatic and musculoskeletal diseases (RMDs) to better self-manage their health. However, guidance on the development and evaluation of such apps is lacking.ObjectivesThe objective of this EULAR task force was to establish points to consider (PtC) for the development, evaluation and implementation of apps for self-management of RMDs.MethodsA systematic literature review of app content and development strategies was conducted, followed by patient focus group and an online survey. Based on this information and along with task force expert opinion, PtC were formulated in a face-to-face meeting by a multidisciplinary task force panel of experts, including two patient research partners. The level of agreement among the panel in regard to each PtC was established by anonymous online voting.ResultsThree overarching principles and 10 PtC were formulated. Three PtC are related to patient safety, considered as a critical issue by the panel. Three are related to relevance of the content and functionalities. The requirement for transparency around app development and funding sources, along with involvement of relevant health professionals, were also raised. Ease of app access across ages and abilities was highlighted, in addition to considering the cost benefit of apps from the outset. The level of agreement was from 8.8 to 9.9 out of 10.ConclusionThese EULAR PtC provide guidance on important aspects that should be considered for the development, evaluation and implementation of existing and new apps.

scholarly journals EULAR recommendations for the management of Sjögren’s syndrome with topical and systemic therapies

2019 ◽  
Vol 79 (1) ◽  
pp. 3-18 ◽  
Author(s):  
Manuel Ramos-Casals ◽  
Pilar Brito-Zerón ◽  
Stefano Bombardieri ◽  
Hendrika Bootsma ◽  
Salvatore De Vita ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Task Force ◽  
Systemic Disease ◽  
Immunosuppressive Agents ◽  
Collaborative Study ◽  
Muscarinic Agonists ◽  
Eular Recommendations ◽  
Logical Sequence ◽  
Patient Representatives ◽  
Saliva Substitutes

The therapeutic management of Sjögren syndrome (SjS) has not changed substantially in recent decades: treatment decisions remain challenging in clinical practice, without a specific therapeutic target beyond the relief of symptoms as the most important goal. In view of this scenario, the European League Against Rheumatism (EULAR) promoted and supported an international collaborative study (EULAR SS Task Force) aimed at developing the first EULAR evidence and consensus-based recommendations for the management of patients with SjS with topical and systemic medications. The aim was to develop a rational therapeutic approach to SjS patients useful for healthcare professionals, physicians undergoing specialist training, medical students, the pharmaceutical industry and drug regulatory organisations following the 2014 EULAR standardised operating procedures. The Task Force (TF) included specialists in rheumatology, internal medicine, oral health, ophthalmology, gynaecology, dermatology and epidemiology, statisticians, general practitioners, nurses and patient representatives from 30 countries of the 5 continents. Evidence was collected from studies including primary SjS patients fulfilling the 2002/2016 criteria; when no evidence was available, evidence from studies including associated SjS or patients fulfilling previous sets of criteria was considered and extrapolated. The TF endorsed the presentation of general principles for the management of patients with SjS as three overarching, general consensus-based recommendations and 12 specific recommendations that form a logical sequence, starting with the management of the central triplet of symptoms (dryness, fatigue and pain) followed by the management of systemic disease. The recommendations address the use of topical oral (saliva substitutes) and ocular (artificial tear drops, topical non-steroidal anti-inflammatory drugs, topical corticosteroids, topical CyA, serum tear drops) therapies, oral muscarinic agonists (pilocarpine, cevimeline), hydroxychloroquine, oral glucocorticoids, synthetic immunosuppressive agents (cyclophosphamide, azathioprine, methotrexate, leflunomide and mycophenolate), and biological therapies (rituximab, abatacept and belimumab). For each recommendation, levels of evidence (mostly modest) and TF agreement (mostly very high) are provided. The 2019 EULAR recommendations are based on the evidence collected in the last 16 years in the management of primary 2002 SjS patients and on discussions between a large and broadly international TF. The recommendations synthesise current thinking on SjS treatment in a set of overarching principles and recommendations. We hope that the current recommendations will be broadly applied in clinical practice and/or serve as a template for national societies to develop local recommendations.

scholarly journals EULAR provisional recommendations for the management of rheumatic and musculoskeletal diseases in the context of SARS-CoV-2

2020 ◽  
Vol 79 (7) ◽  
pp. 851-858 ◽  
Author(s):  
Robert BM Landewé ◽  
Pedro M Machado ◽  
Féline Kroon ◽  
Hans WJ Bijlsma ◽  
Gerd R Burmester ◽  
...  
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Musculoskeletal Diseases ◽  
Task Force ◽  
New Developments ◽  
Social Distancing ◽  
Eular Recommendations ◽  
Starting Point ◽  
Potential Impact ◽  
Prevention Of Infections

The provisional EULAR recommendations address several aspects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus, and the disease caused by SARS-CoV-2, COVID-19 and are meant for patients with rheumatic and musculoskeletal diseases (RMD) and their caregivers. A task force of 20 members was convened by EULAR that met several times by videoconferencing in April 2020. The task force finally agreed on five overarching principles and 13 recommendations covering four generic themes: (1) General measures and prevention of SARS-CoV-2 infection. (2) The management of RMD when local measures of social distancing are in effect. (3) The management of COVID-19 in the context of RMD. (4) The prevention of infections other than SARS-CoV-2. EULAR considers this set of recommendations as a ‘living document’ and a starting point, which will be updated as soon as promising new developments with potential impact on the care of patients with RMD become available.

scholarly journals 2019 EULAR points to consider for the assessment of competences in rheumatology specialty training

2020 ◽  
Vol 80 (1) ◽  
pp. 65-70 ◽  
Author(s):  
Francisca Sivera ◽  
Alessia Alunno ◽  
Aurélie Najm ◽  
Tadej Avcin ◽  
Xenofon Baraliakos ◽  
...  
Keyword(s):  
Musculoskeletal Diseases ◽  
Task Force ◽  
Training Programme ◽  
Assessment Practices ◽  
Specialty Training ◽  
Sufficient Time ◽  
Effective Implementation ◽  
European League Against Rheumatism ◽  
Training Programmes ◽  
Level Of Agreement

Background and aimStriving for harmonisation of specialty training and excellence of care in rheumatology, the European League Against Rheumatism (EULAR) established a task force to develop points to consider (PtCs) for the assessment of competences during rheumatology specialty training.MethodsA systematic literature review on the performance of methods for the assessment of competences in rheumatology specialty training was conducted. This was followed by focus groups in five selected countries to gather information on assessment practices and priorities. Combining the collected evidence with expert opinion, the PtCs were formulated by the multidisciplinary task force, including rheumatologists, medical educationalists, and people with rheumatic and musculoskeletal diseases. The level of agreement (LoA) for each PtC was anonymously voted online.ResultsFour overarching principles and 10 PtCs were formulated. The overarching principles highlighted the importance of assessments being closely linked to the rheumatology training programme and protecting sufficient time and resources to ensure effective implementation. In the PtCs, two were related to overall assessment strategy (PtCs 1 and 5); three focused on formative assessment and portfolio (PtCs 2–4); three focused on the assessment of knowledge, skills or professionalism (PtCs 6–8); one focused on trainees at risk of failure (PtC 9); and one focused on training the trainers (PtC 10). The LoA (0–10) ranged from 8.75 to 9.9.ConclusionThese EULAR PtCs provide European guidance on assessment methods throughout rheumatology training programmes. These can be used to benchmark current practices and to develop future strategies, thereby fostering continuous improvement in rheumatology learning and, ultimately, in patient care.

scholarly journals EULAR recommendations for patient education for people with inflammatory arthritis

2015 ◽  
Vol 74 (6) ◽  
pp. 954-962 ◽  
Author(s):  
Heidi A Zangi ◽  
Mwidimi Ndosi ◽  
Jo Adams ◽  
Lena Andersen ◽  
Christina Bode ◽  
...  
Keyword(s):  
Patient Education ◽  
Health Professionals ◽  
Inflammatory Arthritis ◽  
Research Agenda ◽  
Task Force ◽  
Evidence Based ◽  
Expert Opinions ◽  
Eular Recommendations ◽  
High Level ◽  
Educational Agenda

ObjectivesThe task force aimed to: (1) develop evidence-based recommendations for patient education (PE) for people with inflammatory arthritis, (2) identify the need for further research on PE and (3) determine health professionals’ educational needs in order to provide evidence-based PE.MethodsA multidisciplinary task force, representing 10 European countries, formulated a definition for PE and 10 research questions that guided a systematic literature review (SLR). The results from the SLR were discussed and used as a basis for developing the recommendations, a research agenda and an educational agenda. The recommendations were categorised according to level and strength of evidence graded from A (highest) to D (lowest). Task force members rated their agreement with each recommendation from 0 (total disagreement) to 10 (total agreement).ResultsBased on the SLR and expert opinions, eight recommendations were developed, four with strength A evidence. The recommendations addressed when and by whom PE should be offered, modes and methods of delivery, theoretical framework, outcomes and evaluation. A high level of agreement was achieved for all recommendations (mean range 9.4–9.8). The task force proposed a research agenda and an educational agenda.ConclusionsThe eight evidence-based and expert opinion-based recommendations for PE for people with inflammatory arthritis are intended to provide a core framework for the delivery of PE and training for health professionals in delivering PE across Europe.

scholarly journals 2021 revised algorithm for the management of knee osteoarthritis—the Chinese viewpoint

2021 ◽  
Author(s):  
Zhiyi Zhang ◽  
Cibo Huang ◽  
Yongping Cao ◽  
Rong Mu ◽  
Mun Chan Zhang ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Knee Osteoarthritis ◽  
Musculoskeletal Diseases ◽  
Task Force ◽  
Treatment Algorithm ◽  
Practical Implementation ◽  
Pharmacological Interventions ◽  
High Quality Research ◽  
Knee Oa ◽  
Made In China

Abstract Aim The European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) algorithm for the management of knee osteoarthritis (OA) is available worldwide from 2014, but in 2019 an update was published. Based on this algorithm, a Working Group (WG), including ESCEO members and Chinese experts, wished to see how the new ESCEO algorithm was perceived by Chinese experts in knee OA and how it was integrated into their clinical practice. Methods A WG was held between members of the international ESCEO task force and a group of Chinese experts. Results Non-pharmacological approach should be combined with pharmacological interventions. In step 1, symptomatic slow-acting drugs for osteoarthritis (SYSADOA) are the most important background drugs. Evidence, supported by high-quality research, is available only for crystalline glucosamine sulfate (pCGS) and chondroitin sulfate. Topical NSAIDs could be used as an additional option. In step 2, oral NSAIDs could be useful, but cardiovascular/renal/gastrointestinal profiles of the patients should be considered. Intra-articular hyaluronic acid and corticosteroids are alternative to oral NSAIDs, but the evidence is still limited. If steps 1 and 2 are not sufficient, weak opioids could be used. Overall, the conclusions of the ESCEO algorithm are accepted in China for products available in this country. The WG suggests the importance of economic studies, specifically made in China. Conclusion This work provides evidence-based advice to establish a treatment algorithm in knee OA, for practical implementation in clinical practice in China.

scholarly journals Development of EULAR recommendations for the reporting of clinical trial extension studies in rheumatology

2014 ◽  
Vol 74 (6) ◽  
pp. 963-969 ◽  
Author(s):  
Maya H Buch ◽  
Lucia Silva-Fernandez ◽  
Loreto Carmona ◽  
Daniel Aletaha ◽  
Robin Christensen ◽  
...  
Keyword(s):  
Ethical Issues ◽  
Task Force ◽  
Controlled Trial ◽  
Drop Out ◽  
Eular Recommendations ◽  
European League Against Rheumatism ◽  
Patient Representatives ◽  
Minimal Data ◽  
Definition Of ◽  
Randomised Controlled

ObjectivesOur initiative aimed to produce recommendations on post-randomised controlled trial (RCT) trial extension studies (TES) reporting using European League Against Rheumatism (EULAR) standard operating procedures in order to achieve more meaningful output and standardisation of reports.MethodsWe formed a task force of 22 participants comprising RCT experts, clinical epidemiologists and patient representatives. A two-stage Delphi survey was conducted to discuss the domains of evaluation of a TES and definitions. A ‘0–10’ agreement scale assessed each domain and definition. The resulting set of recommendations was further refined and a final vote taken for task force acceptance.ResultsSeven key domains and individual components were evaluated and led to agreed recommendations including definition of a TES (100% agreement), minimal data necessary (100% agreement), method of data analysis (agreement mean (SD) scores ranging between 7.9 (0.84) and 9.0 (2.16)) and reporting of results as well as ethical issues. Key recommendations included reporting of absolute numbers at each stage from the RCT to TES with reasons given for drop-out at each stage, and inclusion of a flowchart detailing change in numbers at each stage and focus (mean (SD) agreement 9.9 (0.36)). A final vote accepted the set of recommendations.ConclusionsThis EULAR task force provides recommendations for implementation in future TES to ensure a standardised approach to reporting. Use of this document should provide the rheumatology community with a more accurate and meaningful output from future TES, enabling better understanding and more confident application in clinical practice towards improving patient outcomes.

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