Background/Purpose:

The American College of Rheumatology (ACR) regularly establishes and publishes guidelines for the management of various rheumatic diseases. These guidelines assist physicians in providing appropriate care to patients afflicted with rheumatic diseases. The objective of this study is to evaluate the quality of evidence supporting recommendations in the  American College of Rheumatology (ACR) clinical practice guidelines.

Methods: Current guidelines for management of rheumatic diseases posted on the ACR website (http://www.rheumatology.org/) were evaluated using the methods reported by the American College of cardiology as follows: 1) for level of evidence A, data were derived from multiple RCTs or ameta-analysis, 2) for level B evidence, data were derivedfrom a single RCT or nonrandomized study, and 3) for level C evidence, data were derived from consensus, expert opinion, or case series.

Results:

At the time of our review, there were 7 guidelines posted on the ACR website, 5 of which were eligible for data analysis. Two guidelines were excluded ( not followed the same quality of evidence format ). The summary of the distribution is reported as the median of the percentage of all the eligible guidelines. The 5 analyzed guidelines contained a total of 191 recommendations, 56 were supported by Level A evidence (Median, 27.6(%); Inter-quartile range [IQR],15.4%-52.5%); 44 were supported by Level B evidence (Median, 18.9%; IQR,8.3%-33.8%); 91 were supported by Level C evidence (Median,45.2(%); IQR,33.2%-58.6%). (Table 1)

Table 1. Summary of All Current ACR Recommendations Level of Evidence, Number of recommendations (n), Percentage (%), Median (%) and Inter Quartile Range. 47.6% of the recommendation in the available website recommendation are supported by Level C evidence.

Conclusion: The ACR recommendations are supported mainly by level C evidence. These findings highlight the areas which have a paucity of high quality evidence and are not supported by either Level A or B evidence. The study highlights the limitations of current clinical rheumatological diseases research that can provide high quality of evidence. Support of high quality evidence research is crucially needed.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/quality-of-evidence-of-the-american-college-of-rheumatology-acr-clinical-practice-guidlines/