DataSheet_6_A clinical practice guideline for the screening and assessment of enthesitis in patients with spondyloarthritis.docx

ObjectiveThe aim of this review is to provide guidance on the selection of approaches to the screening and assessment of enthesitis in patients with spondyloarthritis (SpA).
MethodsTwenty-four questions regarding the approaches to the screening and assessment of enthesitis and the implementation details were devised, followed by a systemic literature review. The Grading of Recommendations Assessment, Development, and Evaluation methodology was employed in the development of this guideline, with modifications to evaluate non-interventional approaches under comprehensive consideration of costs, accessibility, and evidence strength. A consensus from the voting panel was required for the inclusion of the final recommendations and the strength of each recommendation.
ResultsSeventeen recommendations (including five strong recommendations) were included in this guideline. The voting panel expressed unequivocal support for the necessity of screening and assessment of enthesitis in patients with SpA. It was agreed unanimously that symptom evaluation and physical examination should serve as the initial steps to the recognition of enthesitis, whereas Maastricht Ankylosing Spondylitis Enthesitis Score is a reliable tool in both clinical trials and daily medical practice. Ultrasound examination is another reliable tool, with power Doppler ultrasound as an informative addition. Notwithstanding its high resolution, MRI is limited by the costs and relatively low accessibility, whereas radiographs had low sensitivity and therefore should be rendered obsolete in the assessment of enthesitis. PET/CT was strongly opposed in the detection of enthesitis.
ConclusionThis guideline provides clinicians with information regarding the screening and assessment of enthesitis in patients with SpA. However, this guideline does not intend on dictating choices, and the ultimate decisions should be made in light of the actual circumstances of the facilities.

研究目的：本综述旨在为脊柱关节炎（spondyloarthritis, SpA）患者附着点炎（enthesitis）的筛查与评估方法选择提供指导。
研究方法：本研究拟定了24个有关附着点炎筛查评估方案及实施细节的问题，随后开展系统性文献回顾。本指南采用推荐分级、评估、制定与评价（Grading of Recommendations Assessment, Development, and Evaluation, GRADE）方法学制定，并综合考量成本、可及性与证据强度，对非干预性评估方法进行调整优化。最终纳入的推荐意见及每条推荐的强度等级，均需经投票专家组达成共识后方可确定。
研究结果：本指南最终纳入17条推荐意见（其中5条为强推荐）。投票专家组明确支持对脊柱关节炎患者开展附着点炎筛查与评估的必要性。专家组一致认为，症状评估与体格检查应作为识别附着点炎的初始步骤；马斯特里赫特强直性脊柱炎附着点炎评分（Maastricht Ankylosing Spondylitis Enthesitis Score, MASES）是一项在临床试验与日常临床实践中均具备可靠性的评估工具。超声检查是另一项可靠评估手段，其中能量多普勒超声可提供额外的有价值信息。尽管磁共振成像（Magnetic Resonance Imaging, MRI）分辨率较高，但受限于成本与相对较低的可及性；而X线平片敏感性较低，因此在附着点炎评估中已不再适用。PET/CT在附着点炎检测中被强烈反对使用。
结论：本指南可为临床医师开展脊柱关节炎患者附着点炎的筛查与评估提供参考依据。但本指南并非强制临床决策，最终方案应结合医疗机构的实际情况制定。