Weill Cornell Medicine-Qatar (WCM-Q) has collaborated with international experts to adapt international guidelines for the management of rheumatoid arthritis to the Eastern Mediterranean region.

The objective of this project is toadapt the recently published AmericanCollege of Rheumatology (ACR)Rheumatoid Arthritis (RA) guidelinesto the Eastern Mediterranean Region(EMR) region. The project will applyrigorous evidence synthesis andguidelines adaptation approaches.The adaptation process will considercontextual factors such as the costof medication and the characteristicsof health services in the EMR region.This is a collaborative project betweenthe Weill Cornell Medicine – Qatar(WCM-Q), the Middle East RheumatoidArthritis Consortium (MERAC), and theAmerican University of Beirut (AUB)GRADE Center. It is funded by theQatar National Research Fund (QNRF)and WCM-Q.
Dr Thurayya Arayssi

The project brought together experts from 24 institutions across the region, the US and Canada, to adapt the guidelines of the American College of Rheumatology (ACR) to ‘suit’ local cases. The ultimate aim of the project is to ensure rheumatoid arthritis patients across the Eastern Mediterranean region receive the very best care possible.

Rheumatoid arthritis is characterised by painful inflammation and progressive immobility of the joints, particularly in the hands, feet and cervical spine. While there is currently no cure for rheumatoid arthritis, if treated correctly, symptoms can be alleviated and progression of the disease slowed.

The guideline adaptation project was conducted under the guidance of Dr Thurayya Arayssi, WCM-Q Senior Associate Dean for Medical Education and a practicing rheumatologist, in partnership with Dr Elie Akl, Professor of Medicine and Director of the American University of Beirut (AUB) GRADE Center, and Director of the Clinical Research Institute at AUB.

Because rheumatoid arthritis cannot be cured, treatment focuses on long-term management of the disease, according to Dr Arayssi.

As such, it is very important that rheumatologists have access to the most up-to-date treatment guidelines so their patients receive the best possible care. We have been working with colleagues across the Eastern Mediterranean countries to adapt the guidelines of the ACR so that they suit the local healthcare systems, cultures and economic circumstances.’

Dr Arayssi has been working with fellow clinicians and epidemiologists to systematically analyse each of the treatment guidelines of the ACR and tailor them to cases in the Eastern Mediterranean region. This process of adaptation and development of guidelines (known in the medical world as ‘adolopment’) follows an established protocol that considers factors such as cost, impact on health equities, balance of benefits and harms, and acceptability. Adolopment is considered to be far more efficient in terms of time and expense than creating new or ‘de novo’ guidelines from scratch.

WCM-Q Rheumatoid group
Distinguished rheumatologists from across the Eastern Mediterranean region gather in Doha to discuss the guidelines.

The working group adapted the ACR guidelines in two separate waves, eventually producing 16 recommendations for the management of early and established rheumatoid arthritis in the Eastern Mediterranean region.

Dr Akl said the group led by Dr Arayssi has done pioneering work in terms of regional approach to guideline adaptation.

Other groups, from as far away as Brazil, for example, are learning from our experience to adapt the same guidelines to their own contexts. I believe that the already existing regional network of experts as well as the willingness of the ACR to support this project were key factors for success.’

The results of this process have now been documented in a research paper entitled ‘Recommendations for the management of rheumatoid arthritis in the Eastern Mediterranean region: an adolopment of the 2015 American College of Rheumatology Guidelines’, which has been published in the medical journal, Clinical Rheumatology and in Health and Quality of Life Outcomes, another journal.

The Conference and Workshop Sponsorship Program under the Qatar National Research Fund and WCM-Q funded the first wave of adaptation. The International League of Associations for Rheumatology funded the second wave of adaptation. The research paper can be accessed through this link.