A clinical practice guideline for the screening and assessment of enthesitis in patients with spondyloarthritis
ObjectiveThe aim of this review is to provide guidance on the selection of approaches to the screening and assessment of enthesitis in patients with spondyloarthritis (SpA).MethodsTwenty-four questions regarding the approaches to the screening and assessment of enthesitis and the implementation deta...
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Frontiers Media S.A.
2022-09-01
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| Series: | Frontiers in Immunology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fimmu.2022.978504/full |
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| author | Xinyu Wu Dong Liu Yanfei Li Ya Xie Liudan Tu Yanli Zhang Xi Zhang Linkai Fang Xiqing Luo Zhiming Lin Zetao Liao Limin Rong Jie Ren Yuqi Zhou Niansheng Yang Jian Xu Hua Zhang Baijie Xu Zhenbiao Wu Feng Zhan Zhenbin Li Weiguo Xiao Shengyun Liu Yi Zhou Shanhui Ye Qing Lv Lijun Zhang Dongbao Zhao Shanzhi He Like Zhao Lijun Wu He Lin Yunxiao Zhu Donggeng Guo Zehong Yang Budian Liu Kehu Yang Jieruo Gu |
| author_facet | Xinyu Wu Dong Liu Yanfei Li Ya Xie Liudan Tu Yanli Zhang Xi Zhang Linkai Fang Xiqing Luo Zhiming Lin Zetao Liao Limin Rong Jie Ren Yuqi Zhou Niansheng Yang Jian Xu Hua Zhang Baijie Xu Zhenbiao Wu Feng Zhan Zhenbin Li Weiguo Xiao Shengyun Liu Yi Zhou Shanhui Ye Qing Lv Lijun Zhang Dongbao Zhao Shanzhi He Like Zhao Lijun Wu He Lin Yunxiao Zhu Donggeng Guo Zehong Yang Budian Liu Kehu Yang Jieruo Gu |
| author_sort | Xinyu Wu |
| collection | DOAJ |
| description | ObjectiveThe aim of this review is to provide guidance on the selection of approaches to the screening and assessment of enthesitis in patients with spondyloarthritis (SpA).MethodsTwenty-four questions regarding the approaches to the screening and assessment of enthesitis and the implementation details were devised, followed by a systemic literature review. The Grading of Recommendations Assessment, Development, and Evaluation methodology was employed in the development of this guideline, with modifications to evaluate non-interventional approaches under comprehensive consideration of costs, accessibility, and evidence strength. A consensus from the voting panel was required for the inclusion of the final recommendations and the strength of each recommendation.ResultsSeventeen recommendations (including five strong recommendations) were included in this guideline. The voting panel expressed unequivocal support for the necessity of screening and assessment of enthesitis in patients with SpA. It was agreed unanimously that symptom evaluation and physical examination should serve as the initial steps to the recognition of enthesitis, whereas Maastricht Ankylosing Spondylitis Enthesitis Score is a reliable tool in both clinical trials and daily medical practice. Ultrasound examination is another reliable tool, with power Doppler ultrasound as an informative addition. Notwithstanding its high resolution, MRI is limited by the costs and relatively low accessibility, whereas radiographs had low sensitivity and therefore should be rendered obsolete in the assessment of enthesitis. PET/CT was strongly opposed in the detection of enthesitis.ConclusionThis guideline provides clinicians with information regarding the screening and assessment of enthesitis in patients with SpA. However, this guideline does not intend on dictating choices, and the ultimate decisions should be made in light of the actual circumstances of the facilities. |
| first_indexed | 2024-12-10T14:53:47Z |
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| id | doaj.art-b5927c5fca3a4209820540b77d2d4c73 |
| institution | Directory Open Access Journal |
| issn | 1664-3224 |
| language | English |
| last_indexed | 2024-12-10T14:53:47Z |
| publishDate | 2022-09-01 |
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| series | Frontiers in Immunology |
| spelling | doaj.art-b5927c5fca3a4209820540b77d2d4c732022-12-22T01:44:23ZengFrontiers Media S.A.Frontiers in Immunology1664-32242022-09-011310.3389/fimmu.2022.978504978504A clinical practice guideline for the screening and assessment of enthesitis in patients with spondyloarthritisXinyu Wu0Dong Liu1Yanfei Li2Ya Xie3Liudan Tu4Yanli Zhang5Xi Zhang6Linkai Fang7Xiqing Luo8Zhiming Lin9Zetao Liao10Limin Rong11Jie Ren12Yuqi Zhou13Niansheng Yang14Jian Xu15Hua Zhang16Baijie Xu17Zhenbiao Wu18Feng Zhan19Zhenbin Li20Weiguo Xiao21Shengyun Liu22Yi Zhou23Shanhui Ye24Qing Lv25Lijun Zhang26Dongbao Zhao27Shanzhi He28Like Zhao29Lijun Wu30He Lin31Yunxiao Zhu32Donggeng Guo33Zehong Yang34Budian Liu35Kehu Yang36Jieruo Gu37Department of Rheumatology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, ChinaDepartment of Rheumatology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, ChinaEvidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, ChinaDepartment of Rheumatology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, ChinaDepartment of Rheumatology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, ChinaDepartment of Rheumatology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, ChinaDepartment of Rheumatology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, ChinaDepartment of Rheumatology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, ChinaDepartment of Rheumatology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, ChinaDepartment of Rheumatology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, ChinaDepartment of Rheumatology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, ChinaDepartment of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, ChinaDepartment of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, ChinaDepartment of Pulmonary and Critical Care Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou>, ChinaDepartment of Rheumatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, ChinaDepartment of Internal Medicine, First Affiliated Hospital of Kunming Medical University, Kunming, ChinaDepartment of Rheumatology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, ChinaDepartment of Rheumatology, Jieyang People’s Hospital, Jieyang, China0Department of Rheumatology, Tangdu Hospital of Air Force Military Medical University, Xian, China1Department of Rheumatology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, China2Department of Rheumatology, Bethune International Peace Hospital, People’s Liberation Army, Shijiazhuang, China3Department of Rheumatology, The First Hospital of China Medical University, Shenyang, China4Department of Rheumatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China5Department of Rheumatology and Immunology, First Affiliated Hospital of Jinan University, Guangzhou, China6Department of Rheumatology and Immunology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China7Department of Rheumatology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China8Department of Rheumatology, Shenzhen Hospital, The University of Hong Kong, Shenzhen, China9Department of Rheumatology and Immunology, Changhai Hospital, Naval Medical University, Shanghai, China0Department of Rheumatology, Zhongshan People’s Hospital, Zhongshan, China1Department of Rheumatology and Immunology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China2Department of Rheumatology and Immunology, The People’s Hospital of the Xinjiang Uygur Autonomous Region, Urumqi, China3Department of Rheumatology, Fujian Provincial Hospital, Fuzhou, China4Department of Medical Ultrasonics, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China5Department of Rheumatology and Immunology, Ningxia Clinical Institute of Bone and Joint Research, The Affiliated People’s Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University, Yinchuan, China6Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, ChinaDepartment of Rheumatology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, ChinaEvidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, ChinaDepartment of Rheumatology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, ChinaObjectiveThe aim of this review is to provide guidance on the selection of approaches to the screening and assessment of enthesitis in patients with spondyloarthritis (SpA).MethodsTwenty-four questions regarding the approaches to the screening and assessment of enthesitis and the implementation details were devised, followed by a systemic literature review. The Grading of Recommendations Assessment, Development, and Evaluation methodology was employed in the development of this guideline, with modifications to evaluate non-interventional approaches under comprehensive consideration of costs, accessibility, and evidence strength. A consensus from the voting panel was required for the inclusion of the final recommendations and the strength of each recommendation.ResultsSeventeen recommendations (including five strong recommendations) were included in this guideline. The voting panel expressed unequivocal support for the necessity of screening and assessment of enthesitis in patients with SpA. It was agreed unanimously that symptom evaluation and physical examination should serve as the initial steps to the recognition of enthesitis, whereas Maastricht Ankylosing Spondylitis Enthesitis Score is a reliable tool in both clinical trials and daily medical practice. Ultrasound examination is another reliable tool, with power Doppler ultrasound as an informative addition. Notwithstanding its high resolution, MRI is limited by the costs and relatively low accessibility, whereas radiographs had low sensitivity and therefore should be rendered obsolete in the assessment of enthesitis. PET/CT was strongly opposed in the detection of enthesitis.ConclusionThis guideline provides clinicians with information regarding the screening and assessment of enthesitis in patients with SpA. However, this guideline does not intend on dictating choices, and the ultimate decisions should be made in light of the actual circumstances of the facilities.https://www.frontiersin.org/articles/10.3389/fimmu.2022.978504/fullspondyloarthritisenthesitisscreeningultrasoundmagnetic resonance imaging |
| spellingShingle | Xinyu Wu Dong Liu Yanfei Li Ya Xie Liudan Tu Yanli Zhang Xi Zhang Linkai Fang Xiqing Luo Zhiming Lin Zetao Liao Limin Rong Jie Ren Yuqi Zhou Niansheng Yang Jian Xu Hua Zhang Baijie Xu Zhenbiao Wu Feng Zhan Zhenbin Li Weiguo Xiao Shengyun Liu Yi Zhou Shanhui Ye Qing Lv Lijun Zhang Dongbao Zhao Shanzhi He Like Zhao Lijun Wu He Lin Yunxiao Zhu Donggeng Guo Zehong Yang Budian Liu Kehu Yang Jieruo Gu A clinical practice guideline for the screening and assessment of enthesitis in patients with spondyloarthritis Frontiers in Immunology spondyloarthritis enthesitis screening ultrasound magnetic resonance imaging |
| title | A clinical practice guideline for the screening and assessment of enthesitis in patients with spondyloarthritis |
| title_full | A clinical practice guideline for the screening and assessment of enthesitis in patients with spondyloarthritis |
| title_fullStr | A clinical practice guideline for the screening and assessment of enthesitis in patients with spondyloarthritis |
| title_full_unstemmed | A clinical practice guideline for the screening and assessment of enthesitis in patients with spondyloarthritis |
| title_short | A clinical practice guideline for the screening and assessment of enthesitis in patients with spondyloarthritis |
| title_sort | clinical practice guideline for the screening and assessment of enthesitis in patients with spondyloarthritis |
| topic | spondyloarthritis enthesitis screening ultrasound magnetic resonance imaging |
| url | https://www.frontiersin.org/articles/10.3389/fimmu.2022.978504/full |
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