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Objective To develop evidence-based recommendations on the use of ultrasound (US) and magnetic resonance imaging in patients with spondyloarthritis, including psoriatic arthritis, and juvenile idiopathic arthritis. Methods Recommendations were generated following a nominal group technique. A panel of experts (15 rheumatologists and 3 radiologists) was established in the first panel meeting to define the scope and purpose of the consensus document, as well as chapters, potential recommendations and systematic literature reviews (we used and updated those from previous EULAR documents). A first draft of recommendations and text was generated. Then, an electronic Delphi process (2 rounds) was carried out. Recommendations were voted from 1 (total disagreement) to 10 (total agreement). We defined agreement if at least 70% of participants voted ≥7. The level of evidence and grade or recommendation was assessed using the Oxford Centre for Evidence Based Medicine levels of evidence. The full text was circulated and reviewed by the panel. The consensus was coordinated by an expert methodologist. Results A total of 12 recommendations were proposed for each disease. They include, along with explanations of the validity of US and magnetic resonance imaging regarding inflammation and damage detection, diagnosis, prediction (structural damage progression, flare, treatment response, etc.), monitoring and the use of US guided injections/biopsies. Conclusions These recommendations will help clinicians use US and magnetic resonance imaging in patients with spondyloarthritis and juvenile idiopathic arthritis.

Resumen Objetivo Establecer recomendaciones, basadas en la evidencia, sobre el uso de la ecografia (US) y la resonancia magnetica en pacientes con espondiloartritis, incluyendo la artritis psoriasica, y en la artritis idiopatica juvenil. Metodos Las recomendaciones se consensuaron mediante metodologia basada en grupos nominales. Un grupo de expertos (15 reumatologos y 3 radiologos) definio el alcance, los usuarios, los apartados, las posibles recomendaciones y las revisiones sistematicas a realizar (se utilizaron y actualizaron las revisiones de documentos de consenso de EULAR), y se asignaron tareas. Los expertos delimitaron los apartados y redactaron las recomendaciones. El nivel de evidencia y el grado de recomendacion se establecieron utilizando el sistema del Centre for Evidence Based Medicine de Oxford, y el grado de acuerdo mediante Delphi a 2 rondas. Las recomendaciones se votaron segun una escala de 1 (total desacuerdo) a 10 (total acuerdo), definiendose el acuerdo como una puntuacion ≥ 7 por al menos el 70% de los participantes. El documento fue revisado por los expertos y el proyecto estuvo coordinado por un metodologo experto. Resultados Se emitieron 12 recomendaciones sobre la validez de la US y la resonancia magnetica para la deteccion de actividad y dano estructural, capacidad diagnostica, predictora (de progresion de dano estructural, brote de la enfermedad, respuesta al tratamiento, etc.), utilidad en la evaluacion y monitorizacion del tratamiento, y uso de la US como guia (para infiltraciones, biopsias, etc.) en pacientes con espondiloartritis y artritis idiopatica juvenil. Conclusiones Se presentan unas recomendaciones utiles para el manejo de la US y la resonancia magnetica por los clinicos en pacientes con espondiloartritis y artritis idiopatica juvenil.

Resumen Introduccion En los ultimos anos, el peso especifico de las consultas externas ha aumentado considerablemente. En la actualidad, la mayor parte de la atencion reumatologica se lleva a cabo en esta area del hospital. Sin embargo, apenas existe documentacion respecto a estandares de calidad asistencial. Objetivo Desarrollar, mediante consenso, estandares de calidad asistencial especificos para las consultas externas de reumatologia. Metodo El proyecto se llevo a cabo mediante metodologia Delphi a 2 rondas. Se conto con la participacion de un comite cientifico (13 reumatologos), 5 grupos nominales (45 reumatologos y 12 enfermeras especializadas) y un grupo de discusion formado por 9 pacientes. Se generaron de forma sucesiva diversos borradores hasta obtener un documento final que incluyo los estandares que recibieron una puntuacion igual o superior a 7 en al menos el 70% de los participantes. Resultados El documento consta de 148 estandares distribuidos en 9 areas tematicas: a) estructura (22); b) actividad clinica y relacion con los pacientes (34); c) planificacion (7); d) niveles de prioridad (5); e) relacion con atencion primaria, con el servicio de urgencias y con otros servicios del hospital (20); f) proceso (26); g) enfermeria (13); h) docencia e investigacion (13), e i) computo de actividad (8). Conclusion Se han consensuado unos estandares de calidad asistencial que pueden ser utiles para organizar la actividad en las consultas externas de los servicios de reumatologia y servir como marco de referencia a la hora de elevar propuestas de mejora a la gerencia del hospital o a otros estamentos de la administracion.

Objective To develop evidence-based recommendations on the use of ultrasound (US) and magnetic resonance imaging (MRI) in patients with rheumatoid arthritis (RA). Methods Recommendations were generated following a nominal group technique. A panel of experts, consisting of 15 rheumatologists and 3 radiologists, was established in the first panel meeting to define the scope and purpose of the consensus document, as well as chapters, potential recommendations and systematic literature reviews (we used and updated those from previous EULAR documents). A first draft of recommendations and text was generated. Then, an electronic Delphi process (2 rounds) was carried out. Recommendations were voted from 1 (total disagreement) to 10 (total agreement). We defined agreement if at least 70% of experts voted ≥7. The level of evidence and grade or recommendation was assessed using the Oxford Centre for Evidence-based Medicine Levels of Evidence. The full text was circulated and reviewed by the panel. The consensus was coordinated by an expert methodologist. Results A total of 20 recommendations were proposed. They include the validity of US and MRI regarding inflammation and damage detection, diagnosis, prediction (structural damage progression, flare, treatment response, etc.), monitoring and the use of US guided injections/biopsies. Conclusions These recommendations will help clinicians use US and MRI in RA patients.

Introduction In recent years, outpatient clinics have undergone extensive development. At present, patients with rheumatic diseases are mainly assisted in this area. However, the quality standards of care are poorly documented. Objective To develop specific quality criteria and standards for an outpatient rheumatology clinic. Method The project was based on the two-round Delphi method. The following groups of participants took part: scientific committee (13 rheumatologists), five nominal groups (45 rheumatologists and 12 nurses) and a group of discussion formed by 9 patients. Different drafts were consecutively generated until a final document was obtained that included the standards that received a punctuation equal or over 7 in at least 70% of the participants. Results 148 standards were developed, grouped into the following 9 dimensions: (a) structure (22), (b) clinical activity and relationship with the patients (34), (c) planning (7), (d) levels of priority (5), (e) relations with primary care physicians, with Emergency Department and with other clinical departments, (f) process (26), (g) nursing (13), (h) teaching and research (13) and (i) activity measures (8). Conclusion This study established specific quality standards for rheumatology outpatient clinic. It can be a useful tool for organizing this area in the Rheumatology Department and as a reference when proposing improvement measures to health administrators.