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Winter 2015 (Volume 25, Number 4)

Guidelines Committee:
Update 2015

By Shahin Jamal, BScPT, MD, FRCPC, MSc

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Over the past few years, the CRA Therapeutics Committee has been very active with clinical practice guidelines. As a result, in 2014, the CRA Guidelines Committee was founded to focus specifically on clinical practice guidelines, consensus statements, and disease-management-related position statements. We have been working with Dr. Peter Tugwell and a group at McMaster University to streamline the guideline development process and ensure our methodology is up to date.

Over the past year, our Committee has been very active across many diseases and management spectrums. In the spring, the 2014 Update of the CRA/SPARCC Treatment Recommendations for the Management of Spondyloarthropathy (SpA) were published in two parts in the Journal of Rheumatology.1,2 The CanVasc Recommendations for the management of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides were accepted for publication in the Journal of Rheumatology and published in October 2015. These were both huge undertakings and I commend Dr. Sherry Rohekar, Dr. Christian Pagnoux, and their groups on their hard work and perseverance. Dr. Stephanie Keeling continues to lead a group of Canadian lupologists towards the development of management guidelines for lupus. There was meeting in September 2015 in Toronto, and we are excited to see their findings published within the coming year. The pediatric section of the CRA has developed a Canadian position statement on management of juvenile arthritis. This too will be submitted for publication soon.

Dr. Mary-Ann Fitzcharles has done an excellent job advocating and educating on the use of medicinal marijuana in rheumatic diseases. In the summer of 2014, she published data from a survey of CRA members detailing rheumatologists’ lack of confidence with prescribing cannabinoids.3 This was followed up in January 2015 with an editorial on expanding medicinal marijuana access in Canada for rheumatic disease.4 We have recently submitted a systematic review of randomized controlled trials of the efficacy, tolerability, and safety of cannabinoid treatments in the rheumatic diseases. This will hopefully be published in Arthritis Care and Research in the coming months.

Subsequent entry biologics (SEBs) have arrived in Canada and the CRA has had some involvement in this process. We submitted a position statement to Health Canada in fall 2014, and worked with a group of pharmacology colleagues to disseminate and publish on Canadian rheumatologist attitudes towards SEBs.5 Work in this area continues, and more information can be found at rheum.ca.

We have many projects ongoing: There was a needs assessment circulated to the CRA membership over the summer, focused on management of giant cell arteritis. In the coming months, a similar needs assessments will be distributed on management of inflammatory arthritis in pregnancy; another needs assessment on management of Takayasu’s arteritis (TAK) was recently completed. Based on the results, researchers will be developing clinical practice guidelines in these areas. The groups who developed the rheumatoid arthritis (RA) and fibromyalgia guidelines published in 2011 will be evaluating uptake of these guidelines and working on updates for the future.

Finally, the CRA has supported the Canadian Institute of Health Research (CIHR)-Institute of Musculoskeletal Health and Arthritis (IMHA) James Lind Alliance (JLA) which is looking at priority-setting in fibromyalgia. There has been a recent survey of our membership to determine the top-10 unanswered research questions in the management of adult fibromyalgia. This priority-setting exercise could be used in other areas of research by the major research funding
charities.

I have had the great privilege of chairing the Therapeutics (and now Guidelines) Committee since 2011. I will be stepping down in February 2016 and Dr. Glen Hazlewood will be taking over. I have no doubt that he will do an excellent job! We are very lucky to have such enthusiastic colleagues that continue working hard to improve rheumatology in Canada. I would like to thank all of the passionate members of my Committee and the CRA Board for their time, expertise, support, and dedication. I would particularly like to thank Christine Charnock, without whom none of us could do what we do.

References

1. Rohekar S, Chan J, Tse SM, et al. 2014 Update of the Canadian Rheumatology Association/spondyloarthritis research consortium of Canada treatment recommendations for the management of spondyloarthritis. Part I: principles of the management of spondyloarthritis in Canada. J Rheumatol 2015; 42(4):654-64.

2. Rohekar S, Chan J, Tse SM, et al. 2014 Update of the Canadian Rheumatology Association/Spondyloarthritis Research Consortium of Canada Treatment Recommendations for the Management of Spondyloarthritis. Part II: Specific Management Recommendations. J Rheumatol 2015; 42(4):665-81.

3. Fitzcharles MA, Ste-Marie PA, Clauw JD, et al. Rheumatologists lack confidence in their knowledge of cannabinoids pertaining to the management of rheumatic complaints. BMC Musculoskelet Disord 2014; 15:258.

4. Fitzcharles MA, Jamal S. Expanding medical marijuana access in Canada: considerations for the rheumatologist. J Rheumatol 2015; 42(2):143-5.

5. Grabowski D, Henderson B, Lam D, et al. Attitudes towards subsequent entry biologics/biosimilars: A survey of Canadian rheumatologists. Clin Rheumatol 2015; 34(8):1427-33.

Shahin Jamal, BScPT, MD, FRCPC, MSc
Rheumatologist,
Vancouver General Hospital
Vancouver, British Columbia

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