Gaps between research and recommendations in rheumatoid arthritis

Area of Science:

• Rheumatology
• Clinical Practice Guidelines
• Evidence-Based Medicine

Background:

• Many rheumatoid arthritis (RA) recommendations lack strong evidence.
• Low-grade recommendations can lead to suboptimal clinical practice.
• Identifying and addressing these gaps is crucial for improving patient care.

Purpose of the Study:

• To identify low-grade RA recommendations.
• To analyze the reasons behind their low evidence grading.
• To propose strategies for enhancing the evidence base and recommendation quality.

Main Methods:

• Systematic review of national and international RA guidelines by expert rheumatologists.
• Identification and classification of recommendations with low evidence levels (e.g., Oxford grades C/D).
• Delphi method to prioritize recommendations for further research and propose solutions.

Main Results:

• 192 low-grade RA recommendations were identified across 14 documents, predominantly in treatment.
• Key causes for low grading include absence of supporting studies and misalignment between recommendation text and evidence.
• A list of research questions and study designs was proposed to address critical gaps.

Conclusions:

• There is a significant need for research to strengthen RA clinical practice guidelines.
• Developing and promoting research is essential to bridge the gap between current evidence and clinical recommendations.
• This initiative aims to improve the quality of evidence supporting RA management.