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PARIS – When the American College of Rheumatology and the European League Against Rheumatism unveiled new joint guidelines in June for managing patients with polymyalgia rheumatica, it marked the start of two new features for ACR guideline development.
Creation of the joint polymyalgia rheumatica (PMR) guidelines using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system marked a shift for the ACR in how it generates the database for guideline development. The college’s collaboration with the European League Against Rheumatism (EULAR) on a management guideline was new as well. Both changes will carry forward, while the ACR also will step up the pace at which it puts out guidelines and guideline updates, Dr. Kenneth G. Saag said at the annual European Congress of Rheumatology.
"I’m very pleased with our first-ever joint ACR-EULAR guideline [on PMR] presented at this meeting," said Dr. Saag, professor of medicine at the University of Alabama, Birmingham, and an ACR member active in guideline development.
While preparing the PMR guideline, which took shape using the GRADE methods, he noted, the ACR "developed a new infrastructure that will allow us to do [future guidelines] more adeptly and quickly." This infrastructure is now working with an ACR panel to write updated rheumatoid arthritis management guidelines that are expected to be out next year, said Dr. Saag, who is also director of the Center for Education & Research on Therapeutics of Musculoskeletal Disorders at the university.
"GRADE has been advocated internationally as the state of the art for guidelines. It brings a higher level of transparency to the process," he said in an interview. With the switch to the GRADE method, which involved consultations with members of the Cochrane Collaboration data-review organization, the ACR is "transitioning to a process that is more similar to EULAR’s, with a centralized infrastructure. We are moving toward having more in-house expertise with the GRADE method. We hope it will allow us to update guidelines more quickly." ACR groups are reviewing the college’s existing guidelines to find ones that need updating, as well as new areas for guideline development.
Further guideline collaboration with EULAR, however, faces significant hurdles that will mean joint guidelines will only be possible for selected conditions.
Collaboration between EULAR and ACR on guidelines first began in 2003 and eventually led to joint criteria for rheumatoid arthritis remission as well as the PMR guidelines. "We have come a long way in just a few years. Joint management recommendations are not too easy because of the different health care systems in Europe and the United States, and different attitudes towards conflicts of interest," said Dr. Josef Smolen, who represented EULAR’s perspective at the session.
"The issues [in joint ACR and EULAR guidelines] were sorted out for PMR because it was easy. There are no conflicts of interest when treatment is with glucocorticoids," noted Dr. Smolen, professor and chairman of rheumatology at the Medical University of Vienna.
ACR and EULAR collaboration "has been challenging, but it doesn’t mean we can’t do it, and the fact that we now have some momentum [from the PMR guidelines] is a positive sign," Dr. Saag said.
Dr. Saag said that he has served on advisory or data safety and monitoring boards for nine drug companies, and that he has received research grants from Ardea, Amgen, Merck, and Takeda. Dr. Smolen said that he has received honoraria as a consultant or speaker for 17 drug companies.
On Twitter @mitchelzoler
PARIS – When the American College of Rheumatology and the European League Against Rheumatism unveiled new joint guidelines in June for managing patients with polymyalgia rheumatica, it marked the start of two new features for ACR guideline development.
Creation of the joint polymyalgia rheumatica (PMR) guidelines using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system marked a shift for the ACR in how it generates the database for guideline development. The college’s collaboration with the European League Against Rheumatism (EULAR) on a management guideline was new as well. Both changes will carry forward, while the ACR also will step up the pace at which it puts out guidelines and guideline updates, Dr. Kenneth G. Saag said at the annual European Congress of Rheumatology.
"I’m very pleased with our first-ever joint ACR-EULAR guideline [on PMR] presented at this meeting," said Dr. Saag, professor of medicine at the University of Alabama, Birmingham, and an ACR member active in guideline development.
While preparing the PMR guideline, which took shape using the GRADE methods, he noted, the ACR "developed a new infrastructure that will allow us to do [future guidelines] more adeptly and quickly." This infrastructure is now working with an ACR panel to write updated rheumatoid arthritis management guidelines that are expected to be out next year, said Dr. Saag, who is also director of the Center for Education & Research on Therapeutics of Musculoskeletal Disorders at the university.
"GRADE has been advocated internationally as the state of the art for guidelines. It brings a higher level of transparency to the process," he said in an interview. With the switch to the GRADE method, which involved consultations with members of the Cochrane Collaboration data-review organization, the ACR is "transitioning to a process that is more similar to EULAR’s, with a centralized infrastructure. We are moving toward having more in-house expertise with the GRADE method. We hope it will allow us to update guidelines more quickly." ACR groups are reviewing the college’s existing guidelines to find ones that need updating, as well as new areas for guideline development.
Further guideline collaboration with EULAR, however, faces significant hurdles that will mean joint guidelines will only be possible for selected conditions.
Collaboration between EULAR and ACR on guidelines first began in 2003 and eventually led to joint criteria for rheumatoid arthritis remission as well as the PMR guidelines. "We have come a long way in just a few years. Joint management recommendations are not too easy because of the different health care systems in Europe and the United States, and different attitudes towards conflicts of interest," said Dr. Josef Smolen, who represented EULAR’s perspective at the session.
"The issues [in joint ACR and EULAR guidelines] were sorted out for PMR because it was easy. There are no conflicts of interest when treatment is with glucocorticoids," noted Dr. Smolen, professor and chairman of rheumatology at the Medical University of Vienna.
ACR and EULAR collaboration "has been challenging, but it doesn’t mean we can’t do it, and the fact that we now have some momentum [from the PMR guidelines] is a positive sign," Dr. Saag said.
Dr. Saag said that he has served on advisory or data safety and monitoring boards for nine drug companies, and that he has received research grants from Ardea, Amgen, Merck, and Takeda. Dr. Smolen said that he has received honoraria as a consultant or speaker for 17 drug companies.
On Twitter @mitchelzoler
PARIS – When the American College of Rheumatology and the European League Against Rheumatism unveiled new joint guidelines in June for managing patients with polymyalgia rheumatica, it marked the start of two new features for ACR guideline development.
Creation of the joint polymyalgia rheumatica (PMR) guidelines using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system marked a shift for the ACR in how it generates the database for guideline development. The college’s collaboration with the European League Against Rheumatism (EULAR) on a management guideline was new as well. Both changes will carry forward, while the ACR also will step up the pace at which it puts out guidelines and guideline updates, Dr. Kenneth G. Saag said at the annual European Congress of Rheumatology.
"I’m very pleased with our first-ever joint ACR-EULAR guideline [on PMR] presented at this meeting," said Dr. Saag, professor of medicine at the University of Alabama, Birmingham, and an ACR member active in guideline development.
While preparing the PMR guideline, which took shape using the GRADE methods, he noted, the ACR "developed a new infrastructure that will allow us to do [future guidelines] more adeptly and quickly." This infrastructure is now working with an ACR panel to write updated rheumatoid arthritis management guidelines that are expected to be out next year, said Dr. Saag, who is also director of the Center for Education & Research on Therapeutics of Musculoskeletal Disorders at the university.
"GRADE has been advocated internationally as the state of the art for guidelines. It brings a higher level of transparency to the process," he said in an interview. With the switch to the GRADE method, which involved consultations with members of the Cochrane Collaboration data-review organization, the ACR is "transitioning to a process that is more similar to EULAR’s, with a centralized infrastructure. We are moving toward having more in-house expertise with the GRADE method. We hope it will allow us to update guidelines more quickly." ACR groups are reviewing the college’s existing guidelines to find ones that need updating, as well as new areas for guideline development.
Further guideline collaboration with EULAR, however, faces significant hurdles that will mean joint guidelines will only be possible for selected conditions.
Collaboration between EULAR and ACR on guidelines first began in 2003 and eventually led to joint criteria for rheumatoid arthritis remission as well as the PMR guidelines. "We have come a long way in just a few years. Joint management recommendations are not too easy because of the different health care systems in Europe and the United States, and different attitudes towards conflicts of interest," said Dr. Josef Smolen, who represented EULAR’s perspective at the session.
"The issues [in joint ACR and EULAR guidelines] were sorted out for PMR because it was easy. There are no conflicts of interest when treatment is with glucocorticoids," noted Dr. Smolen, professor and chairman of rheumatology at the Medical University of Vienna.
ACR and EULAR collaboration "has been challenging, but it doesn’t mean we can’t do it, and the fact that we now have some momentum [from the PMR guidelines] is a positive sign," Dr. Saag said.
Dr. Saag said that he has served on advisory or data safety and monitoring boards for nine drug companies, and that he has received research grants from Ardea, Amgen, Merck, and Takeda. Dr. Smolen said that he has received honoraria as a consultant or speaker for 17 drug companies.
On Twitter @mitchelzoler
EXPERT ANALYSIS FROM THE EULAR CONGRESS 2014
