Toshihide Mimura1,2, Yuya Kondo3, Akihide Ohta4, Masahiro Iwamoto5, Akiko Ota6, Nami Okamoto7, Yasushi Kawaguchi8, Hajime Kono9, Yoshinari Takasaki10, Shuji Takei11, Norihiro Nishimoto12, Manabu Fujimoto13, Yu Funakubo Asanuma1, Akio Mimori14, Naoko Okiyama13, Shunta Kaneko3, Hiroyuki Takahashi3, Masahiro Yokosawa3, Takayuki Sumida3. 1. a Department of Rheumatology and Applied Immunology , Saitama Medical University , Saitama , Japan. 2. b Center for Intractable Diseases, Saitama Medical University , Saitama , Japan. 3. c Department of Internal Medicine, Faculty of Medicine , University of Tsukuba , Ibaraki , Japan. 4. d Faculty of Medicine , Saga University , Saga , Japan. 5. e Department of Internal Medicine, Division of Rheumatology/Clinical Immunology , Jichi Medical University , Tochigi , Japan. 6. f Department of Social Medicine, Faculty of Medicine, Division of Public Health , Saitama Medical University , Saitama , Japan. 7. g Department of Pediatrics , Osaka Medical College , Osaka , Japan. 8. h Institute of Rheumatology, Tokyo Women's Medical University , Tokyo , Japan. 9. i Department of Internal Medicine , Teikyo University School of Medicine , Tokyo , Japan. 10. j Department of Rheumatology , Juntendo University Koshigaya Hospital , Saitama , Japan. 11. k Faculty of Medicine, School of Health Sciences , Kagoshima University , Kagoshima , Japan. 12. l Department of Molecular Regulation for Intractable Diseases , Institute of Medical Science, Tokyo Medical University , Tokyo , Japan. 13. m Department of Dermatology, Faculty of Medicine , University of Tsukuba , Ibaraki , Japan. 14. n Department of Rheumatology , Iwate Prefectural Central Hospital , Iwate , Japan.
Abstract
OBJECTIVES: Using an expert- and data-driven methodology, we have constructed the first clinical practice guidelines (CPGs) for adult Still's disease (ASD) after complete systematic review (SR) of the literature based upon the Medical Information Network Distribution Service (Minds) procedure. METHODS: The CPG committee for ASD organized by the Research Team for Autoimmune Diseases, the Research Program for Intractable Disease of the Japanese Ministry of Health, Labour, and Welfare has developed CPG for ASD 2017, according to the procedure proposed by Minds. The CPG development process includes (1) clarification of the purpose of CPG, (2) organization of the steering committee, (3) organization of the CPG committee and secretariat, (4) defining the scope (setting of clinical questions (CQs)), (5) SR, (6) development of recommendations, (7) drafting the CPG, (8) external evaluation and public comments, and (9) release. Because we wanted to construct CPG for ASD to encompass both adult-onset Still's disease (AOSD) and adult patients with systemic juvenile idiopathic arthritis (sJIA), we also included SR data from sJIA in this study. RESULTS: Twenty-six CQs were selected and roughly divided into the following items: (1) clinical findings (CQs 1-4), (2) laboratory findings (CQs 5-8), (3) complications (CQs 9-13), (4) treatment with oral medicine (CQs 14-19), (5) treatment with biological reagents (CQs 20-23), and (6) treatments for sJIA (CQs 25-26). Recommendations and the strength of the recommendations for these CQs were decided by a modified Delphi method. CONCLUSION: We have developed the first published CPG for ASD including AOSD and sJIA, which includes 26 CQs and recommendations. This guideline will help rheumatologists, non-specialized physicians, other healthcare providers, medical and health-related students, and patients and their family members to understand and treat ASD.
OBJECTIVES: Using an expert- and data-driven methodology, we have constructed the first clinical practice guidelines (CPGs) for adult Still's disease (ASD) after complete systematic review (SR) of the literature based upon the Medical Information Network Distribution Service (Minds) procedure. METHODS: The CPG committee for ASD organized by the Research Team for Autoimmune Diseases, the Research Program for Intractable Disease of the Japanese Ministry of Health, Labour, and Welfare has developed CPG for ASD 2017, according to the procedure proposed by Minds. The CPG development process includes (1) clarification of the purpose of CPG, (2) organization of the steering committee, (3) organization of the CPG committee and secretariat, (4) defining the scope (setting of clinical questions (CQs)), (5) SR, (6) development of recommendations, (7) drafting the CPG, (8) external evaluation and public comments, and (9) release. Because we wanted to construct CPG for ASD to encompass both adult-onset Still's disease (AOSD) and adult patients with systemic juvenile idiopathic arthritis (sJIA), we also included SR data from sJIA in this study. RESULTS: Twenty-six CQs were selected and roughly divided into the following items: (1) clinical findings (CQs 1-4), (2) laboratory findings (CQs 5-8), (3) complications (CQs 9-13), (4) treatment with oral medicine (CQs 14-19), (5) treatment with biological reagents (CQs 20-23), and (6) treatments for sJIA (CQs 25-26). Recommendations and the strength of the recommendations for these CQs were decided by a modified Delphi method. CONCLUSION: We have developed the first published CPG for ASD including AOSD and sJIA, which includes 26 CQs and recommendations. This guideline will help rheumatologists, non-specialized physicians, other healthcare providers, medical and health-related students, and patients and their family members to understand and treat ASD.