RESUMO
Therapy for polymyalgia rheumatica (PMR) varies widely in clinical practice as international recommendations for PMR treatment are not currently available. In this paper, we report the 2015 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) recommendations for the management of PMR. We used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology as a framework for the project. Accordingly, the direction and strength of the recommendations are based on the quality of evidence, the balance between desirable and undesirable effects, patients' and clinicians' values and preferences, and resource use. Eight overarching principles and nine specific recommendations were developed covering several aspects of PMR, including basic and follow-up investigations of patients under treatment, risk factor assessment, medical access for patients and specialist referral, treatment strategies such as initial glucocorticoid (GC) doses and subsequent tapering regimens, use of intramuscular GCs and disease modifying anti-rheumatic drugs (DMARDs), as well as the roles of non-steroidal anti-rheumatic drugs and non-pharmacological interventions. These recommendations will inform primary, secondary and tertiary care physicians about an international consensus on the management of PMR. These recommendations should serve to inform clinicians about best practices in the care of patients with PMR.
Assuntos
Polimialgia Reumática/tratamento farmacológico , Algoritmos , Antirreumáticos/uso terapêutico , Pesquisa Biomédica/métodos , Gerenciamento Clínico , Esquema de Medicação , Medicina Baseada em Evidências/métodos , Glucocorticoides/administração & dosagem , Glucocorticoides/uso terapêutico , Humanos , Cooperação Internacional , Fitoterapia/métodos , Polimialgia Reumática/diagnósticoRESUMO
Therapy for polymyalgia rheumatica (PMR) varies widely in clinical practice as international recommendations for PMR treatment are not currently available. In this paper, we report the 2015 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) recommendations for the management of PMR. We used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology as a framework for the project. Accordingly, the direction and strength of the recommendations are based on the quality of evidence, the balance between desirable and undesirable effects, patients' and clinicians' values and preferences, and resource use. Eight overarching principles and nine specific recommendations were developed covering several aspects of PMR, including basic and follow-up investigations of patients under treatment, risk factor assessment, medical access for patients and specialist referral, treatment strategies such as initial glucocorticoid (GC) doses and subsequent tapering regimens, use of intramuscular GCs and disease modifying anti-rheumatic drugs (DMARDs), as well as the roles of non-steroidal anti-rheumatic drugs and non-pharmacological interventions. These recommendations will inform primary, secondary and tertiary care physicians about an international consensus on the management of PMR. These recommendations should serve to inform clinicians about best practices in the care of patients with PMR.
Assuntos
Polimialgia Reumática/tratamento farmacológico , Antirreumáticos/efeitos adversos , Antirreumáticos/uso terapêutico , Europa (Continente) , Glucocorticoides/efeitos adversos , Glucocorticoides/uso terapêutico , Humanos , Fatores de Risco , Estados UnidosRESUMO
Staffing data (staff mix and nursing care hours) and patient outcome indicator data (falls, skin integrity, nosocomial infections, and satisfaction) from a pilot study are presented. These data provide a compelling case for developing databases and collection systems that capture standardized indicator and staffing data to address issues about the quality of nursing care. They also underscore the need for establishing benchmarks that represent targets of excellence as well as determining what constitutes adequate staffing.