Living guidelines a world-first in rheumatology
Musculoskeletal researchers at the Australia and New Zealand Musculoskeletal (ANZMUSC) Clinical Trials Network have delivered the world’s first living guidelines in rheumatology, continuing the School’s trailblazing work demonstrating the feasibility and value of this model of guideline generation. These guidelines ensure clinicians and patients have access to the most current, evidence-based management of musculoskeletal health conditions.
Clinical guidelines form the backbone of medical best practice around the world, guiding doctors in how to test and treat patients for a variety of medical conditions. The time between guideline updates has traditionally been marked by years, as they involve substantial research and interpretation, and achieving consensus between clinicians, researchers, and consumers.
The model of living guidelines drastically reduces this timeframe, by creating an almost real-time system of searching for, assessing and incorporating relevant peer-reviewed medical literature as soon as it becomes available. Depending upon how active the research area is for a particular question, searches are conducted as frequently as weekly to every three months. If new evidence is identified that may change a recommendation, the panel reconvenes to consider whether the guidance needs to be updated.
The agility and speed with which living guidelines can be updated allows for rapid inclusion of contemporary issues. For instance, earlier this year ANZMUSC issued evidence-based guidance on COVID-19 vaccination for people with autoimmune inflammatory rheumatic diseases on drug treatments that modify their immune response.
The first of the NHMRC-endorsed living rheumatology guidelines was released in September 2020. Eleven guidelines have now been published on adult inflammatory arthritis, and one for juvenile idiopathic arthritis, with the first six recommendations endorsed by the NHMRC in July 2021. Around four to five per cent of Australian adults live with inflammatory arthritis, and one in every thousand children 14 years or under has juvenile arthritis.
ANZMUSC Chair, Professor Rachelle Buchbinder AO, says “This has been a truly rewarding project to be a part of, and it really exemplifies the Network’s ability to contribute to the transformation of care on an international level.
“Debilitating arthritis has a huge impact on small but vital tasks in life, through joint pain and swelling, reduced mobility, physical weakness and fatigue. I’m proud that we’ve been able to lead this improvement in care for affected people, and I think this provides yet more evidence that this model of guideline is the way of the future.”
The Network is an active member of the Australian Living Evidence Consortium (ALEC), an initiative that has spun out of several successful living evidence projects arising within the School of Public Health and Preventive Medicine.
It’s been a whirlwind year for the ANZMUSC team – the rheumatology guidelines have been presented via keynote presentations at several international meetings during 2021, been cited as high-priority by Australian rheumatologists via survey, have contributed to decision aids produced in partnership with NPS MedicineWise, and served as learning tool to teach others and streamline and improve living guideline formation and future updates.
The Canadian Rheumatology Association has also recently adopted one of the recommendations, and 2022 and beyond offer hope of further international collaborations on guidelines.