Multinational evidence-based recommendations on how to investigate and follow-up undifferentiated peripheral inflammatory arthritis: integrating systematic literature research and expert opinion of a broad international panel of rheumatologists in the 3E Initiative

Pedro Machado*, I. Castrejon, W. Katchamart, R. Koevoets, B. Kuriya, M. Schoels, L. Silva-Fernandez, K. Thevissen, Ward Vercoutere, E. Villeneuve, D. Aletaha, L. Carmona, R. Landewe, D. van der Heijde, Johannes W J Bijlsma, Vivian Bykerk, Helena Canhao, Anca I. Catrina, Patrick Durez, Christopher J. EdwardsMaria D. Mjaavatten, Burkhard F. Leeb, B. Losada, Emilio Martin-Mola, Pindaro Martinez-Osuna, Carlomaurizio Montecucco, Ulf Mueller-Ladner, M. Ostergaard, B. Sheane, Ricardo M. Xavier, J. Zochling, C. Bombardier

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

39 Citations (Web of Science)


Objective To develop evidence-based recommendations on how to investigate and follow-up undifferentiated peripheral inflammatory arthritis (UPIA). Methods 697 rheumatologists from 17 countries participated in the 3E (Evidence, Expertise, Exchange) Initiative of 2008-9 consisting of three separate rounds of discussions and modified Delphi votes. In the first round 10 clinical questions were selected. A bibliographic team systematically searched Medline, Embase, the Cochrane Library and ACR/EULAR 2007-2008 meeting abstracts. Relevant articles were reviewed for quality assessment, data extraction and synthesis. In the second round each country elaborated a set of national recommendations. Finally, multinational recommendations were formulated and agreement among the participants and the potential impact on their clinical practice was assessed. Results A total of 39 756 references were identified, of which 250 were systematically reviewed. Ten multinational key recommendations about the investigation and follow-up of UPIA were formulated. One recommendation addressed differential diagnosis and investigations prior to establishing the operational diagnosis of UPIA, seven recommendations related to the diagnostic and prognostic value of clinical and laboratory assessments in established UPIA (history and physical examination, acute phase reactants, autoantibodies, radiographs, MRI and ultrasound, genetic markers and synovial biopsy), one recommendation highlighted predictors of persistence (chronicity) and the final recommendation addressed monitoring of clinical disease activity in UPIA. Conclusions Ten recommendations on how to investigate and follow-up UPIA in the clinical setting were developed. They are evidence-based and supported by a large panel of rheumatologists, thus enhancing their validity and practical use.
Original languageEnglish
Pages (from-to)15-24
JournalAnnals of the Rheumatic Diseases
Issue number1
Publication statusPublished - Jan 2011

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