Axial spondyloarthritis guidelines - aiming for maximum impact

Area of Science:

• Rheumatology
• Clinical Practice Guidelines
• Implementation Science

Background:

• Axial spondyloarthritis (axSpA) clinical practice guidelines (CPGs) are crucial for evidence-based patient care.
• Recent guidelines from ASAS/EULAR and PANLAR, with upcoming updates from ACR/SAA/SPARTAN and APLAR, highlight evolving standards.
• The GRADE framework is increasingly adopted for developing high-quality axSpA CPGs.

Purpose of the Study:

• To review international axSpA CPGs, focusing on their methodology, quality, and implementation strategies.
• To identify variations in guideline development and presentation.
• To assess the current state of axSpA CPG implementation and identify areas for improvement.

Main Methods:

• Systematic review of recently published and upcoming international axSpA clinical practice guidelines.
• Analysis of guideline development methodologies, including the use of frameworks like GRADE.
• Evaluation of reported implementation strategies and adherence studies.

Main Results:

• Significant differences exist among axSpA CPGs in recommendation presentation.
• Implementation strategies are acknowledged but often lack detail.
• Studies show poor adherence to physical therapy/exercise and disease monitoring recommendations.
• Barriers to guideline uptake involve healthcare professionals and guideline characteristics.

Conclusions:

• AxSpA CPGs need user-friendly formats for practical application.
• 'Living guidelines' could improve content currency.
• Emphasis on implementation strategies and further research into barriers is critical for successful axSpA CPG adoption.