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Khuyến nghị về quản lý bệnh viêm cột sống dính khớp theo ASAS/EULAR
Tóm tắt
Mục tiêu: Điều chỉnh và triển khai các khuyến nghị dựa trên bằng chứng do Nhóm làm việc Quốc tế "Đánh giá về Viêm cột sống dính khớp (ASAS)" phối hợp cùng với "Liên minh Châu Âu chống thấp khớp" (EULAR, hiệp hội các bác sĩ thấp khớp châu Âu) phát triển cho việc quản lý bệnh viêm cột sống dính khớp (AS) trong khuôn khổ Mạng lưới chuyên môn (KNW) về Thấp khớp ở khu vực nói tiếng Đức. Phương pháp: Trong dự án ASAS/EULAR, đã tính toán sức mạnh hiệu ứng (effect size, ES), tỷ lệ điều trị (rate ratio, RR), số lượng bệnh nhân cần điều trị (number needed to treat, NNT) và tỷ lệ chi phí-hiệu quả gia tăng (incremental cost-effectiveness ratio, ICER, tỷ lệ thay đổi chi phí so với thay đổi hiệu quả). Sức mạnh của các khuyến nghị được xác định qua mức độ bằng chứng từ tìm kiếm tài liệu, qua đánh giá rủi ro-lợi ích (risk-benefit trade-off) và kinh nghiệm lâm sàng của các chuyên gia. Các khuyến nghị đã được công bố gần đây bằng tiếng Anh. Tất cả các trung tâm tham gia vào trọng tâm Viêm cột sống dính khớp (SpA) của KNW và 35 chuyên gia khác đã nhận được bản thảo tiếng Anh. Tất cả 35 người tham gia đã được yêu cầu đánh giá 10 khuyến nghị chính cho việc quản lý AS một cách định lượng (đánh giá đồng ý theo thang điểm 0-10). Kết quả: Các khuyến nghị bao gồm việc sử dụng các loại thuốc như thuốc chống viêm không steroid (NSAR), bên cạnh các NSAR thông thường, cũng bao gồm Coxib và việc sử dụng đồng thời các thuốc bảo vệ dạ dày, cũng như các thuốc điều chỉnh bệnh "disease-modifying anti-rheumatic drugs" (DMARDs), thuốc sinh học, giảm đau đơn giản, glucocorticoid tại chỗ và toàn thân, các liệu pháp không dùng thuốc (như giáo dục bệnh nhân, liệu pháp tập luyện y tế và vật lý trị liệu) cũng như các biện pháp điều trị phẫu thuật. Hơn nữa, 3 khuyến nghị tổng quát đã được đưa ra và một sơ đồ điều trị đã được xây dựng dựa trên các biểu hiện lâm sàng khác nhau. Sức mạnh của các khuyến nghị ASAS/EULAR là khá rõ rệt. Sự đồng thuận của các chuyên gia nói tiếng Đức với đề xuất quốc tế là rất cao: trung bình là 9,13, với độ biến đổi tương đối nhỏ giữa các khuyến nghị. Tóm tắt: Mười khuyến nghị chính cho việc điều trị AS đã được phát triển, được hỗ trợ bởi việc tìm kiếm tài liệu hệ thống và được các chuyên gia đồng thuận xác nhận. Một nhóm lớn các chuyên gia nói tiếng Đức đã đồng thuận với đề xuất này. Điều này có thể được coi là điểm xuất phát cho việc phân phối và triển khai thêm.
Từ khóa
#Quản lý bệnh viêm cột sống dính khớp #ASAS #EULAR #thuốc chống viêm không steroid #liệu pháp không dùng thuốc #DMARDsTài liệu tham khảo
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