肺部疾病是Sjögren综合征的潜在严重但未被诊断的并发症,第二常见的自身免疫性风湿病。大约16%的干燥综合征患者表现出肺部受累,死亡率更高,生活质量更低。
Sjögren基金会在确定了早期诊断和提高护理质量和一致性的关键需求后,制定了Sjögren肺部表现的临床实践指南。
根据美国风湿病学会指南,遵循严格和透明的方法。肺部主题审查组(TRG)在PICO中开发了临床问题(患者,干预,比较,结果)格式和选定的文献检索参数。每篇文章至少由两名TRG成员进行审查,以评估证据质量和建议强度。然后根据现有证据起草了指导方针,专家意见,和临床重要性。带有临床基本原理和数据提取表的建议草案已提交共识专家小组审议和批准,对于最终版本中包含的个人建议,至少需要75%的同意。
文献检索显示1192篇文章,其中150人有资格在指导方针制定中予以考虑。在TRG最初提出的85个PICO问题中,提出了52项建议。然后,共识专家小组对这些建议进行了审查,并最终确定了52项建议,平均一致性为97.71%(范围,79%-100%)。建议涵盖评估Sjögren患者的肺部表现和评估的主题,管理,治疗上、下气道疾病,间质性肺病,和淋巴增生性疾病.
Sjögren肺部表现的临床实践指南将改善早期识别,评估,以及初级保健医生护理的统一性,风湿病学家,和肺科医生。此外,确定了未来研究的机会。
Pulmonary disease is a potentially serious yet underdiagnosed complication of Sjögren\'s syndrome, the second most common autoimmune rheumatic disease. Approximately 16% of patients with Sjögren\'s demonstrate pulmonary involvement with higher mortality and lower quality of life.
Clinical practice
guidelines for
pulmonary manifestations of Sjögren\'s were developed by the Sjögren\'s Foundation after identifying a critical need for early diagnosis and improved quality and consistency of care.
A rigorous and transparent methodology was followed according to American College of Rheumatology guidelines. The Pulmonary Topic Review Group (TRG) developed clinical questions in the PICO (Patient, Intervention, Comparison, Outcome) format and selected literature search parameters. Each article was reviewed by a minimum of two TRG members for eligibility and assessment of quality of evidence and strength of recommendation. Guidelines were then drafted based on available evidence, expert opinion, and clinical importance. Draft recommendations with a clinical rationale and data extraction tables were submitted to a
Consensus Expert Panel for consideration and approval, with at least 75% agreement required for individual recommendations to be included in the final version.
The literature search revealed 1,192 articles, of which 150 qualified for consideration in
guideline development. Of the original 85 PICO questions posed by the TRG, 52 recommendations were generated. These were then reviewed by the
Consensus Expert Panel and 52 recommendations were finalized, with a mean agreement of 97.71% (range, 79%-100%). The recommendations span topics of evaluating Sjögren\'s patients for pulmonary manifestations and assessing, managing, and treating upper and lower airway disease, interstitial lung disease, and lymphoproliferative disease.
Clinical practice
guidelines for
pulmonary manifestations in Sjögren\'s will improve early identification, evaluation, and uniformity of care by primary care physicians, rheumatologists, and pulmonologists. Additionally, opportunities for future research are identified.