09 January 2020
Our clinical guidelines lead the way in promoting best practice and evidence-based guidance to members. We have 13 guidelines available to help support your work in key areas specific to rheumatology, including lupus, gout, axial spondyloarthritis and biological DMARD safety. We spoke to the Chair of our Standards, Audits and Guidelines Working Group (SAGWG), Professor Ian Giles, about production and formulation of guidelines.
Professor Giles explains: “Our guidelines help guide best practice and are very much developed to support clinical decision-making at the coalface. When you are sat in front of a patient, it gives you that extra confidence that you are making the right decision in line with the latest evidence.”
He says guidelines give comfort to patients: “You can reassure patients that your decision about their treatment is backed by a group of experts who have reviewed the latest evidence to produce guideline recommendations. Furthermore, having BSR’s name attached to the guideline means that a national body has accredited them and provides quality assurance for both patients and healthcare professionals alike.”
The process
We encourage members to not only use the guidelines, but to pitch their own ideas where there are gaps in clinical knowledge or advice. The SAGWG committee then review the proposal, considering how relevant it is to rheumatology as a specialty and if it can be informed by a reasonable evidence base.
If chosen, guideline proposers are asked to form a specialist interest working group to develop the guideline. A member of SAGWG will be assigned to be on the working group and act as a link between the two. Creating our guidelines is a major voluntary effort by members, patients and practitioners, so we are grateful to everyone who helps us!
Professor Giles led on the development of our two-part guidelines on prescribing anti-rheumatic drugs in pregnancy and breastfeeding, an example of how each guideline is a collaborative effort.
He explains: “We had junior and senior rheumatologists as well as obstetric physicians, obstetricians, GPs, pharmacists and, of course patients, help support us with the development. Each guideline we produce needs a broad representation of different specialists and stakeholders."
Members and non-members say the guidelines are very effective. In Prof Giles’ case, he’s seen the pregnancy guidelines used widely. He's been approached about them by healthcare professionals from the UK, Australia, and more recently, while in India! He adds: "In particular, doctors from various different medical specialities have told me how useful it is to have a summary of which drugs to use in pregnancy."
Traditionally, our guidelines were written from an adult patient perspective, but this is changing, as we work to ensure our guidelines are also relevant to those in paediatric and adolescent practice.”
We encourage members to apply the guidelines to their own work, but Prof Giles says to remember that they are intended as an aid to clinical judgement and can’t provide the answers to every clinical question. In particular, members mustn’t consider them to be 'legally binding' rules, and the ultimate decision about any individual patients’ treatment rests upon informed discussion between the patient and their clinical team, which may lead to adjustment of recommendations if there is good reason to.
What's next?
We currently have several new guidelines in various stages of development; giant cell arteritis is coming on 23 January 2020. Other topics in production include the management of psoriatic arthritis with biologics; idiopathic inflammatory myopathy, foot health in inflammatory arthritis and hot swollen joint.
All our guidelines are published in our journal, Rheumatology, under an open access licence, so everyone can benefit from them. We'd love to know more about your experience of using the guidelines, so please get in touch if you're willing to provide a case study. You can find out more about our guidelines here and contact us at guidelines@rheumatology.org.uk.