Tunisian recommendations for the diagnosis and evaluation of Spondyloarthritis.

Advancements in understanding SpA have greatly improved patient quality of life through early detection and effective treatment. However, non-specialist physicians often face challenges in identifying the early symptoms of SpA.

Aim: This study aims to assist healthcare practitioners in the early detection of SpA and to streamline management strategies by employing a standardized assessment protocol for adult patients with SpA. LITAR collaborated with fifteen rheumatologists to adhere to INEAS guidelines. The team created a comprehensive repository based on seven PICO questions and their answers. To create this repository, the team combined local Tunisian data and insights from relevant literature sources using a synthesis method.

Results: This research culminated in the formulation of twelve evidence-based recommendations for best practices, encompassing three critical domains. Firstly, it addresses the clinical indications and signs that should alert primary care physicians to consider a SpA diagnosis and promptly refer patients to rheumatologists. Secondly, it outlines the diagnostic procedures involved in confirming SpA. Lastly, it presents standardized methods for evaluating and monitoring the progression of SpA. To ensure the robustness of these recommendations, an independent reading group of 19 experts from various related specialties validated them. Subsequently, a panel of 54 Tunisian rheumatologists practicing in diverse sectors, including public health, academia, and the private sector, evaluated the strength of these recommendations. The strength ratings ranged from 8 to 9, with a degree of agreement spanning from 72% to 100%.

Conclusion: This guideline, developed with the support of LITAR and accredited by INEAS, serves the overarching goal of facilitating the early diagnosis and comprehensive evaluation of all SpA phenotypes and associated comorbidities.