42 Egyptian evidence-based consensus recommendations for diagnosis and targeted management of juvenile dermatomyositis. An initiative by the Egyptian College of Pediatric Rheumatology

Background

Objective

Methods

Results

Conclusion

The implication to policy, practice, research and advocacy

001 Egyptian consensus-based recommendations for the diagnosis and targeted management of Kawasaki disease. An initiative by the Egyptian College of Pediatric Rheumatology

Background

Objectives

Methods

Results

Conclusion

The implication to policy, practice, research and advocacy

Updated clinical practice treat-to-target guidelines for JIA management: the Egyptian College of Pediatric Rheumatology initiative

Background

These updated guidelines aimed to provide appropriate and convenient guidelines for the treatment of various types of juvenile idiopathic arthritis (JIA).

Using the Delphi technique, this study was conducted to reach expert consensus on a treat-to-target management strategy for JIA. According to the PICO (patient/population, intervention, comparison, and outcomes) approach, the preliminary scientific committee identified a total of 17 key clinical questions. To assemble evidence on the advantages and dangers associated with JIA treatments, an evidence-based, systematic literature review was conducted. Researchers and clinicians with experience in JIA management were identified by the core leadership team. To establish a consensus on the management suggestions for JIA patients, a Delphi approach (2 rounds) was used.

Results

An online survey was applied to the expert panel (n = 27), and 26 of them completed both rounds. At the conclusion of round 2, a total of eighteen (18) recommendation items were gathered, which were divided into four sections to address the four key JIA categories. The percentage of those who agreed with the recommendations (ranks 7–9) ranged from 83.2 to 100% (average 86.8%). The phrasing of all 18 clinical standards identified by the scientific committee was agreed upon (i.e. 75% of respondents strongly agreed or agreed). Algorithms have been proposed for the management of JIA polyarthritis, oligoarthritis, and systemic JIA.

Conclusion

A wide and representative panel of experts initiated a consensus about the management of JIA. The created guidelines give a complete approach to the management of JIA for all healthcare professionals involved in its management, as well as a means of monitoring and evaluating these guidelines on a regular basis.

P063 Consensus-based recommendations for treat to target management of immunoglobulin A vasculitis

Background

IgAvasculitis (IgAV) is the commonest cause of vasculitis in childhood.

It is characterized by small vessel vasculitis of the skin, gastrointestinal tract, kidneys, joints, and, rarely, the lungs and the central nervous system. There is paucity of international guidelines for management of IgA V. the Objective is to develop guidelines specific for Egyptian children with IgA vasculitis.

Method

This study was carried out to achieve an Egyptian expert consensus on a treat-to-target management strategy for IgA vasculitis using Delphi technique. The preliminary scientific committee identified a total of 16 key clinical questions according to the Patient/Population, Intervention, Comparison, and Outcomes (PICO) approach. Delphi process was implemented (2-rounds) to reach a consensus.

Results

An online questionnaire were sent to expert panel (n = 26) who participated in the two rounds. At the end of round 2, a total of 20 recommendation items, categorized into 2 sections were obtained. Agreement with the recommendations (rank 7–9) ranged from 91.7–100%. Consensus was reached (i.e. ≥75% of respondents strongly agreed or agreed) on the wording of all the 20 clinical standards identified by the scientific committee. Algorithms for the management have been suggested.

Conclusion

This was an expert, consensus recommendations for the diagnosis and treatment of IgA V and IgA V nephritis, based on best available evidence and expert opinion.

P016 Updated Clinical Practice Guidelines for JIA management adopting Treat to Target approach: the Egyptian College of Paediatric Rheumatology initiative

Background

There is an unmet need from paediatric rheumatologists and rheumatologists, managing children with JIA, for a well formulated guidelines aiming at achieving better outcomes of their patients. To establish adequate and easily adopted guidelines in management of different variants of JIA in a relatively low resources country.

Method

This study was carried out to achieve an Egyptian expert consensus on a treat-to-target management strategy for Juvenile Idiopathic Arthritis using Delphi technique. The preliminary scientific committee identified a total of 17 key clinical questions according to the Patient/Population, Intervention, Comparison, and Outcomes (PICO) approach. An evidence-based, systematic, literature review was conducted to compile evidence for the benefits and harms associated with JIA treatments. The core leadership team identified researchers and clinicians with expertise in JIA management in Egypt upon which Experts were gathered from different governorates and health centres across Egypt. Delphi process was implemented (2-rounds) to reacha consensus on the management recommendations of Egyptian JIA patients. Results: An online questionnaire were sent to expert panel (n = 27), of whom 26 participated in the two rounds. At the end of round 2, a total of eighteen (18) recommendation items, categorized into 4 sections to address the main 4 JIA categories, were obtained. Agreement with the recommendations (rank 7–9) ranged from 83.2–100% (average 86.8%). Consensus was reached (i.e. ≥75% of respondents strongly agreed or agreed) on the wording of all the 18 clinical standards identified by the scientific committee. Algorithms for the management of JIA polyarthritis, oligoarthritis and systemic JIA have been suggested.

Conclusion

A wide and representative panel of experts established a consensus regarding the management of JIA in Egypt. The developed guidelines provide a comprehensive approach to the management of JIA for ll Egyptian healthcare professionals who are involved in its management for follow up and frequent evaluation of these guidelines.

P050 Consensus based practice guidelines for the management and treatment of Juvenile familial Mediterranean fever: the Egyptian College of Paediatric Rheumatology initiative

Background

Familial Mediterranean fever (FMF) is the most common monogenic auto-inflammatory disease, with the highest prevalence amongst Mediterranean countries including Egypt (where there is high carrier rate of MEFV gene), characterized by recurrent attacks of fever and polyserositis. Mutations in the MEFV gene encoding pyrin has been associated with the disease, which causes exaggeration of the inflammatory response through uncontrolled interleukin production. Issuing updated treatment recommendations are vital for the treating healthcare professionals to get well acquainted with its diagnosis & treatment. To produce consensus-based recommendations to guide the early diagnosis, management and follow-up of patients with FMF.

Methods

The Patient/Population, Intervention, Comparison, and Outcomes (PICO) questions were developed and refined by the core team.

A qualitative synthesis of scientific evidence based on systematic review and clinical experience was conducted to compile evidence for the diagnosis and management of FMF.

A consensus process was conducted among the expert panel to generate the final recommendations and grade their strength.

3 rounds of Delphi process were carried out.

Results

Following 3 Delphi rounds, recommendations were developed for: early diagnosis, who to treat, treatment targets, genetic testing and its interpretation in association with clinical presentation, treatment of FMF and dealing with acute attacks, monitoring of management, identify treatment response, systemic affection, persistent attacks or inflammation, resistant cases, protracted symptoms, as well as remission status.

Algorithm for patients’ diagnosis and management is provided.

The final document comprises 12 recommendations, each presented with its degree of agreement (0–10), Level of agreement, grade of recommendation and rationale. The degree of agreement was >7/10 in all instances.

Conclusion

This guideline provides comprehensive approach to the accurate diagnosis and effective management/monitoring of FMF. It also represents a model for the incorporation of medical genetics practice into the more traditional domains of general medicine.

AB1238 THE ARABIC LUPUSPRO: CROSS-CULTURAL VALIDATION OF A DISEASE-SPECIFIC PATIENT-REPORTED OUTCOME TOOL FOR QUALITY OF LIFE IN LUPUS PATIENTS

Background:

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with high morbidity and disability that affects all aspects of quality of life (QoL).(1)LupusPRO is a disease-targeted patient-reported outcome tool for the measurement of health and non-health related quality of life (HRQoL and Non-HRQoL) in SLE patients.(2)

Objectives:

To translate, cross-culturally adapt, and validate the LupusPRO v.1.8 into the Arabic Language.

Methods:

LupusPRO v.1.8 was translated into Arabic following the forward-backward translation guideline.(3)The Arabic version of LupusPRO was subsequently applied to 107 Egyptian SLE patients. To assess test-retest reliability, the Arabic LupusPRO was completed on two occasions, two weeks apart. Validation was performed against the Arabic version of Medical Outcomes Study Short Form (SF-36), the Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI) and the Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index (SDI). Discriminant validity of Arabic LupusPRO was evaluated against the SF-36 (item 1), while the conceptual framework was evaluated by the confirmatory factor analysis (CFA).

Results:

The study included 107 patients, 95% of whom were women. Their median age was 32 (range:18-55) years. Arabic LupusPRO’s Cronbach’s alpha ranged from 0.71 to 0.98 except for the social support domain (0.65). Test-retest reliability ranged from 0.83 to 0.98. Convergent validity with corresponding domains of the SF-36 was satisfactory. Criterion validity showed a weak and non-significant correlation of lupusPRO domains with SDI except for physical domain and significant weak correlation with SELENA-SLEDAI (Table1). Discriminant validity showed acceptable results against the SF-36 (item 1). The CFA showed good model fit indices for the hypothesized item-to-scale relationships (CFI =0.988, TLI = 0.987, and RMSEA=0.062), with most of item-to-scale loadings greater than 0.9.

Conclusion:

The Arabic version of LupusPRO v1.8 is a reliable and valid tool for measuring QoL(HRQoL and Non-HRQoL) in Arabic-speaking SLE patients.

References:

[1]Mcelhone K, Abbott J, Teh L-SJL. A review of health- related quality of life in systemic lupus erythematosus. Lupus 2006;15(10):633-43.

[2]Jolly M, Pickard AS, Block JA, et al. Disease-specific patient reported outcome tools for systemic lupus erythematosus. Semin Arthritis Rheum. 2012;42(1):56–65.

[3]Beaton D, Bombardier C, Guillemin F, Ferraz M. Guidelines for the Process of Cross-Cultural Adaption of Self-Report Measures. Spine. 2001;25:3186-91.

Table 1.

Validity of the Arabic LupusPRO against disease activity, damage index and SF-36

LupusPRO DomainValiditySF-36Total SLEDAITotal SDIDomainRho (P)Rho (P)Rho (P)Lupus Symptoms-0.25 (0.010)-0.17 (0.08)Cognition-0.15 (0.117)-0.21 (0.03)Lupus Medications-0.22 (0.021)-0.37 (0.001)Procreation0.003 (0.977)-0.20 (0.04)Physical HealthRF0.84 (<0.001)-0.34 (<0.001)-0.31 (0.001)RP0.75 (<0.001)Sleep-0.32 (0.001)-0.09 (0.33)FatigueVT0.80 (<0.001)-0.33 (0.001)-0.12 (0.33)PainBP0.86 (<0.001)-0.22 (0.026)-0.18 (0.07)Emotional HealthMH0.74 (<0.001)-0.33 (0.001)-0.19 (0.05)RE0.80 (<0.001)Body Image-0.30 (0.002)-0.25 (0.008)Desire/Goals-0.28 (0.004)-0.10 (0.30)Social Support0.22 (0.02)-0.20 (0.04)Coping0.07 (0.461)-0.20 (0.03)Satisfaction of Medical Care0.18 (0.066)-0.11 (0.24)HRQoLGH0.81 (<0.001)-0.37 (<0.001)-0.28 (0.004)None-HRQoL-0.08 (0.42)-0.26 (0.007)

PF: Physical functioning; RP: role physical; RE: role emotional; VT: vitality; MH: Mental health; BP: Bodily Pain; GH: General health.

Disclosure of Interests:

None declared

Facilitating patient-centered care: the development of illustrated multidimensional patient-reported outcome measures for children/adolescents with juvenile idiopathic arthritis

OBJECTIVES

To assess the validity, reliability, comprehensibility, and responsiveness to change of an illustrated child/parent multidimensional patient-reported outcome measures (PROMs) questionnaire which can assess construct outcome measures of children with juvenile inflammatory arthritis.

METHODS

A total of 122 children with juvenile idiopathic arthritis were included in this work in a multicenter study. The questionnaire included seven categories: (1) functional ability; (2) health-related quality of life; (3) disease activity measures: pain, global assessment, fatigue, and morning stiffness; (4) self-reported joint tenderness; (5) current medication, side effects, and adherence to therapy; (6) comorbidities; and (7) patient motivation. All the items were supported by illustrations to provide children with a visual impression of what was meant by the questions. The questionnaire has parent and patient versions. The disease activity status was assessed using JADAS-27.

RESULTS

The questionnaire was reliable as demonstrated by a high-standardized alpha (0.890-0.978). The questionnaire items correlated significantly (p < 0.01) with clinical parameters of disease activity. The patient-reported tender joints correlated significantly with the physician's scores (0.842). Changes in functional disability, quality of life, and the motivation score showed significant variation (p < 0.01) with disease activity status in response to therapy. The illustrated PROMs questionnaire showed also a high degree of comprehensibility (9.6).

CONCLUSIONS

Integrating PROMs into standard clinical practice is feasible and applicable. The illustrated questionnaire was valid and reliable. It provides an informative, quantitative measure for the disease activity score set data, and in the meantime, facilitates the assessment of the children's adherence to therapy, comorbidities, and motivation on an individual basis.