2
Key Points
Guideline Summary:
` This guideline provides evidence-based recommendations for the
screening and treatment of Interstitial Lung Disease (ILD) in people
with Systemic Autoimmune Rheumatic Diseases (SARDs) (Rheumatoid
Arthritis [RA], Systemic Sclerosis [SSc], Idiopathic Inflammatory
Myositis [IIM including polymyositis, dermatomyositis, antisynthetase
syndrome, immune-mediated necrotizing myopathy], Mixed Connective
Tissue Disease [MCTD], and Sjögren's Disease [SjD]) associated with
the greatest risk of ILD, and for monitoring for ILD progression.
Table 1. Quality of Evidence and Strength of
Recommendations
Quality of
Evidence Interpretation
High-quality
evidence
Studies that provide high confidence in the effect estimate. New data
from future studies are thought unlikely to change the effect.
Moderate-quality
evidence
Studies that provide moderate confidence that the true effect is likely to be
close to the estimate but possibly could be substantially different.
Low-quality
evidence
Studies that provide limited confidence about the effect. e true effect
may be substantially different from the estimate.
Very low-quality
evidence
Studies that provide very little confidence about the effect. e true
effect may be quite different from the estimate.
Strength of
Recommendation Interpretation
Strong
recommendation
Supported by moderate- to high-quality evidence (e.g., multiple
randomized controlled trials). Recommended course of action would
apply to all or almost all patients. Only a small proportion of clinicians/
patients would not want to follow the recommendation. In rare
instances, a strong recommendation may be based on very low- to
low-certainty evidence. For example, an intervention may be strongly
recommended if it is considered benign, low-cost, without harms, and
the consequence of not performing the intervention may be catastrophic.
An intervention may be strongly recommended against if there is high
certainty of more harm than the comparison with very low or low
certainty about its benefit.
Conditional
recommendation
Supported by lower-quality evidence or a close balance between desirable
and undesirable outcomes. Recommended course of action would
apply to the majority of the patients, but the alternative is a reasonable
consideration. Conditional recommendations always warrant a shared
decision-making approach, reflecting individual values and preferences.
Ungraded Position
Statement
Evidence for a PICO question did not support a graded
recommendation or did not favor one intervention over the other;
guidance for this question provided by the voting panel.
Adapted from: Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating
quality of evidence and strength of recommendations. BMJ 2008; 336 :924–6, and GRADE
Working Group, list of GRADE working group publications and grants. Available at: https://www.
gradeworkinggroup.org/publications.html.
