Stephanie O Keeling1,2, Zainab Alabdurubalnabi3,4, Antonio Avina-Zubieta3,4, Susan Barr3,4, Louise Bergeron3,4, Sasha Bernatsky3,4, Josiane Bourre-Tessier3,4, Ann Clarke3,4, Alexandra Baril-Dionne3,4, Jan Dutz3,4, Stephanie Ensworth3,4, Aurore Fifi-Mah3,4, Paul R Fortin3,4, Dafna D Gladman3,4, Derek Haaland3,4, John G Hanly3,4, Linda T Hiraki3,4, Sara Hussein3,4, Kimberly Legault3,4, Deborah Levy3,4, Lily Lim3,4, Mark Matsos3,4, Emily G McDonald3,4, Jorge Medina-Rosas3,4, Jordi Pardo Pardi3,4, Christine Peschken3,4, Christian Pineau3,4, Janet Pope3,4, Tamara Rader3,4, Jen Reynolds3,4, Earl Silverman3,4, Konstantinos Tselios3,4, Manon Suitner3,4, Murray Urowitz3,4, Zahi Touma3,4, Evelyne Vinet3,4, Nancy Santesso3,4. 1. From the Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Canadian Arthritis Patient Alliance; Division of Rheumatology, Department of Medicine, McGill University; Division of Rheumatology, Department of Medicine, Université de Montréal, Montreal; Division of Rheumatology, Department of Medicine, Université Laval, Quebec City, Quebec; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto; Division of Rheumatology, Department of Medicine, McMaster University, Hamilton, Ontario; Division of Rheumatology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia; Division of Rheumatology, Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario; Division of Rheumatology, Department of Medicine, University of Manitoba, Winnipeg, Manitoba; General Internal Medicine, McGill University Health Centre, McGill University, Montreal, Quebec; Cochrane Musculoskeletal Group, University of Ottawa, Ottawa; Division of Rheumatology, Department of Medicine, Western University, London, Ontario; Canadian Agency for Drugs and Technologies in Health, Ottawa; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton; Centre for Practice-changing Research, Ottawa Hospital Research Institute, Ottawa, Ontario. Stephanie.keeling@ualberta.ca. 2. S.O. Keeling, MD, MSc, FRCP(C), Division of Rheumatology, Department of Medicine, University of Alberta; Z. Alabdurubalnabi, MBBS, ABIM, FRCPC, Division of Rheumatology, Department of Medicine, University of British Columbia; A. Avina-Zubieta, MD, MSc, PhD, FRCPC, Division of Rheumatology, Department of Medicine, University of British Columbia; S. Barr, MD, MSc, FRCPC, Associate Professor, University of Calgary; S. Bernatsky, MD, PhD, FRCPC, Professor of Medicine, McGill University; J. Bourre-Tessier, MD, MSc, FRCPC, Associate Clinical Professor, Université de Montréal; A. Clarke, MD, MSc, FRCPC, Professor of Medicine, Cumming School of Medicine, University of Calgary; A. Baril-Dionne, MD, Internal Medicine Resident, Université de Montréal; J. Dutz, MD, FRCPC, Professor of Medicine, University of British Columbia; S. Ensworth, MD FRCPC, Clinical Assistant Professor, University of British Columbia; A. Fifi-Mah, MD, FRCPC, Clinical Assistant Professor, University of Calgary; P.R. Fortin, MD, FRCPC, Professor of Medicine, Université Laval; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto; D. Haaland, MD, MSc, FRCPC, Assistant Clinical Professor, McMaster University; J.G. Hanly, MD, FRCPC, Professor of Medicine, Dalhousie University; L.T. Hiraki, MD, FRCPC, ScD, Assistant Professor, University of Toronto; S. Hussein, MD, Internal Medicine Resident, Université de Montréal; K. Legault, MD, MSc, FRCPC, Assistant Professor, McMaster University; D. Levy, MD, MSc, FRCPC, Associate Professor, University of Toronto; L. Lim, MBBS, MRCPCH, FRCPC, PhD, Assistant Professor, University of Manitoba; M. Matsos, MD, FRCPC, Associate Professor, McMaster University; E.G. McDonald, MD, FRCPC, Assistant Professor, McGill University; J. Pardo Pardi, Co-Managing Editor, Cochrane Musculoskeletal Group, Centre for Practice-changing Research, Ottawa Hospital Research Institute; C. Peschken, MD, FRCPC, Associate Professor, University of Manitoba; C. Pineau, MD, FRPCP, Associate Professor, McGill University; J. Pope, MD, FRCP(C), Professor of Medicine, Western University; T. Rader, MLIS, Canadian Agency for Drugs and Technologies in Health; J. Reynolds, MD, FRCPC, Clinical Assistant Professor, University of British Columbia; E. Silverman, MD, FRCPC, Professor of Pediatrics, University of Toronto; K. Tselios, MD, PhD, Clinical Research Fellow, University of Toronto; M. Suitner, MD, Internal Medicine Resident, Université de Montréal; M. Urowitz, MD, FRCPC, Professor of Medicine, University of Toronto; Z. Touma, MD, PhD, Assistant Professor, University of Toronto; E. Vinet, MD, PhD, Assistant Professor, McGill University; N. Santesso, RD, PhD, Assistant Professor, McMaster University. Louise Bergeron and Dr. Jorge Medina-Rosas died before the manuscript was completed. Stephanie.keeling@ualberta.ca. 3. From the Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Canadian Arthritis Patient Alliance; Division of Rheumatology, Department of Medicine, McGill University; Division of Rheumatology, Department of Medicine, Université de Montréal, Montreal; Division of Rheumatology, Department of Medicine, Université Laval, Quebec City, Quebec; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto; Division of Rheumatology, Department of Medicine, McMaster University, Hamilton, Ontario; Division of Rheumatology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia; Division of Rheumatology, Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario; Division of Rheumatology, Department of Medicine, University of Manitoba, Winnipeg, Manitoba; General Internal Medicine, McGill University Health Centre, McGill University, Montreal, Quebec; Cochrane Musculoskeletal Group, University of Ottawa, Ottawa; Division of Rheumatology, Department of Medicine, Western University, London, Ontario; Canadian Agency for Drugs and Technologies in Health, Ottawa; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton; Centre for Practice-changing Research, Ottawa Hospital Research Institute, Ottawa, Ontario. 4. S.O. Keeling, MD, MSc, FRCP(C), Division of Rheumatology, Department of Medicine, University of Alberta; Z. Alabdurubalnabi, MBBS, ABIM, FRCPC, Division of Rheumatology, Department of Medicine, University of British Columbia; A. Avina-Zubieta, MD, MSc, PhD, FRCPC, Division of Rheumatology, Department of Medicine, University of British Columbia; S. Barr, MD, MSc, FRCPC, Associate Professor, University of Calgary; S. Bernatsky, MD, PhD, FRCPC, Professor of Medicine, McGill University; J. Bourre-Tessier, MD, MSc, FRCPC, Associate Clinical Professor, Université de Montréal; A. Clarke, MD, MSc, FRCPC, Professor of Medicine, Cumming School of Medicine, University of Calgary; A. Baril-Dionne, MD, Internal Medicine Resident, Université de Montréal; J. Dutz, MD, FRCPC, Professor of Medicine, University of British Columbia; S. Ensworth, MD FRCPC, Clinical Assistant Professor, University of British Columbia; A. Fifi-Mah, MD, FRCPC, Clinical Assistant Professor, University of Calgary; P.R. Fortin, MD, FRCPC, Professor of Medicine, Université Laval; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto; D. Haaland, MD, MSc, FRCPC, Assistant Clinical Professor, McMaster University; J.G. Hanly, MD, FRCPC, Professor of Medicine, Dalhousie University; L.T. Hiraki, MD, FRCPC, ScD, Assistant Professor, University of Toronto; S. Hussein, MD, Internal Medicine Resident, Université de Montréal; K. Legault, MD, MSc, FRCPC, Assistant Professor, McMaster University; D. Levy, MD, MSc, FRCPC, Associate Professor, University of Toronto; L. Lim, MBBS, MRCPCH, FRCPC, PhD, Assistant Professor, University of Manitoba; M. Matsos, MD, FRCPC, Associate Professor, McMaster University; E.G. McDonald, MD, FRCPC, Assistant Professor, McGill University; J. Pardo Pardi, Co-Managing Editor, Cochrane Musculoskeletal Group, Centre for Practice-changing Research, Ottawa Hospital Research Institute; C. Peschken, MD, FRCPC, Associate Professor, University of Manitoba; C. Pineau, MD, FRPCP, Associate Professor, McGill University; J. Pope, MD, FRCP(C), Professor of Medicine, Western University; T. Rader, MLIS, Canadian Agency for Drugs and Technologies in Health; J. Reynolds, MD, FRCPC, Clinical Assistant Professor, University of British Columbia; E. Silverman, MD, FRCPC, Professor of Pediatrics, University of Toronto; K. Tselios, MD, PhD, Clinical Research Fellow, University of Toronto; M. Suitner, MD, Internal Medicine Resident, Université de Montréal; M. Urowitz, MD, FRCPC, Professor of Medicine, University of Toronto; Z. Touma, MD, PhD, Assistant Professor, University of Toronto; E. Vinet, MD, PhD, Assistant Professor, McGill University; N. Santesso, RD, PhD, Assistant Professor, McMaster University. Louise Bergeron and Dr. Jorge Medina-Rosas died before the manuscript was completed.
Abstract
OBJECTIVE: To develop recommendations for the assessment of people with systemic lupus erythematosus (SLE) in Canada. METHODS: Recommendations were developed using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. The Canadian SLE Working Group (panel of Canadian rheumatologists and a patient representative from Canadian Arthritis Patient Alliance) was created. Questions for recommendation development were identified based on the results of a previous survey of SLE practice patterns of members of the Canadian Rheumatology Association. Systematic literature reviews of randomized trials and observational studies were conducted. Evidence to Decision tables were prepared and presented to the panel at 2 face-to-face meetings and online. RESULTS: There are 15 recommendations for assessing and monitoring SLE, with varying applicability to adult and pediatric patients. Three recommendations focus on diagnosis, disease activity, and damage assessment, suggesting the use of a validated disease activity score per visit and annual damage score. Strong recommendations were made for cardiovascular risk assessment and measuring anti-Ro and anti-La antibodies in the peripartum period and conditional recommendations for osteoporosis and osteonecrosis. Two conditional recommendations were made for peripartum assessments, 1 for cervical cancer screening and 2 for hepatitis B and C screening. A strong recommendation was made for annual influenza vaccination. CONCLUSION: These are considered the first guidelines using the GRADE method for the monitoring of SLE. Existing evidence is largely of low to moderate quality, resulting in more conditional than strong recommendations. Additional rigorous studies and special attention to pediatric SLE populations and patient preferences are needed.
OBJECTIVE: To develop recommendations for the assessment of people with systemic lupus erythematosus (SLE) in Canada. METHODS: Recommendations were developed using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. The Canadian SLE Working Group (panel of Canadian rheumatologists and a patient representative from Canadian ArthritisPatient Alliance) was created. Questions for recommendation development were identified based on the results of a previous survey of SLE practice patterns of members of the Canadian Rheumatology Association. Systematic literature reviews of randomized trials and observational studies were conducted. Evidence to Decision tables were prepared and presented to the panel at 2 face-to-face meetings and online. RESULTS: There are 15 recommendations for assessing and monitoring SLE, with varying applicability to adult and pediatric patients. Three recommendations focus on diagnosis, disease activity, and damage assessment, suggesting the use of a validated disease activity score per visit and annual damage score. Strong recommendations were made for cardiovascular risk assessment and measuring anti-Ro and anti-La antibodies in the peripartum period and conditional recommendations for osteoporosis and osteonecrosis. Two conditional recommendations were made for peripartum assessments, 1 for cervical cancer screening and 2 for hepatitis B and C screening. A strong recommendation was made for annual influenza vaccination. CONCLUSION: These are considered the first guidelines using the GRADE method for the monitoring of SLE. Existing evidence is largely of low to moderate quality, resulting in more conditional than strong recommendations. Additional rigorous studies and special attention to pediatric SLE populations and patient preferences are needed.