Tunisian Recommendations for Best Practices in the Management of Spondyloarthritis: Methodology

Abstract

This framework was developed under the auspices of the Tunisian League Against Rheumatism (LITAR), coordinated by a project leader. The primary objective is to formulate recommendations for the management of spondyloarthritis, grounded in the development of questions structured according to the PICO model. This model defines four essential elements of a clinical question: P: Patient or Population or Problem, I: Intervention (the proposed action), C: Comparison (between diagnostic tests, treatments, etc.), and O: Outcome (clinical results, measured events, judgment criteria, etc.). A working group was established, coordinated by a project leader appointed by LITAR. This group included rheumatologists recognized as experts in the disease by the scientific community, as well as a methodological and epidemiological rheumatologist. The bibliographic search focused on international literature (meta-analyses, randomized controlled trials, cohort studies, case-control studies, etc.) and other sources of information (HAS, clinical practice guidelines), as well as national literature (theses, dissertations, publications, conference presentations). In-person and virtual meetings of the working group enabled the formulation of the recommendations, following the presentation of literature data and extensive discussions among the experts. The draft of the recommendations was submitted to the same experts for validation and assessment of the level of agreement, which determined the strength of the recommendations. Subsequently, the recommendations were reviewed by a reading group appointed by the working group. The final version was adjusted based on feedback from both groups.