Abstract Clinical practice guidelines (CPG) are developed to align standards of health care around the world, aiming to reduce the incidence of misconducts and enabling more effective use of health resources. Considering the complexity, cost, and time involved in formulating CPG, strategies should be used to facilitate and guide authors through each step of this process. The main objective of this document is to present a methodological guide prepared by the Epidemiology Committee of the Brazilian Society of Rheumatology for the elaboration of CPG in rheumatology. Through an extensive review of the literature, this study compiles the main practical recommendations regarding the following steps of CPG drafting: distribution of working groups, development of the research question, search, identification and selection of relevant studies, evidence synthesis and quality assessment of the body of evidence, the Delphi methodology for consensus achievement, presentation and dissemination ofthe recommendations, CPG quality assessment and updating. This methodological guide serves as an important tool for rheumatologists to develop reliable and high-quality CPG, standardizing clinical practices worldwide. (CPG world resources complexity cost process rheumatology literature drafting groups question search studies achievement updating highquality high worldwide

OBJETIVO: Descrever as principais alterações nos ombros de pacientes portadores de espondilite anquilosante (EA) por meio de ultra-som (US) e correlacionar os achados de imagem com a idade e o tempo de doença. MÉTODOS: Foram selecionados 35 pacientes com diagnóstico clínico de EA. Os pacientes foram submetidos a exame de ultra-sonografia dos ombros, sendo avaliados os tendões do manguito rotador quanto à sua ecotextura e espessura, o tendão do bíceps, a articulação acromioclavicular, os tubérculos umerais, a bursa subacromial-subdeltóidea, e a face posterior da articulação glenoumeral. Foram colhidos dados de tempo de doença, presença de dor nos ombros e freqüência das alterações das estruturas avaliadas. Os dados foram comparados com a idade e o tempo de doença, utilizando-se teste qui-quadrado e teste t de Student. RESULTADOS: Foi observada prevalência de 20% de alterações no manguito rotador, sendo 10% de tendinose/calcificação tendínea e 10% de rupturas tendíneas. A espessura média dos tendões do manguito rotador foi de 5,8 mm. As alterações ósseas nos tubérculos do úmero ocorreram em 84,3% dos ombros e as alterações acromioclaviculares em 54,3% dos ombros. CONCLUSÃO: Não há modificação da espessura dos tendões do manguito rotador relacionadas com o tempo de doença. Os principais achados de US, que se correlacionam com o tempo de doença na EA, são alterações ósseas nos tubérculos umerais e na articulação acromioclavicular. Não houve relação entre tempo de doença e presença de lesão tendínea.

PURPOSE: To describe shoulder involvement and its prevalence with ultrasound in patients with ankylosing spondylitis and correlate the findings with age and duration of disease. METHODS: Ultrasound scans of both shoulders were performed in thirty five selected patients with clinical diagnosis of ankylosing spondylitis. Rotator cuff texture and thickness were evaluated as well as the biceps tendon, acromioclavicular joint, humeral head tuberosities, subacromial-subdeltoid bursa, and posterior glenohumeral joint. Besides the prevalence of shoulder involvement, information about presence of pain and duration of disease were registered. The data were compared with age and duration of disease using chi-square and Student's t tests. RESULTS: The prevalence of rotator cuff disease was 20%; with 10% of tendinosis/tendon calcification and 10% of partial/full thickness tears. The mean rotator cuff thickness was 5.8 mm. Irregularities of the humeral head tuberosities were present in 84.3% of shoulders and acromioclavicular irregularities were present in 54.3% of shoulders. CONCLUSION: There was no change in rotator cuff thickness related with duration of disease. Bony irregularities in humeral head tuberosities and acromioclavicular joint were the main finding associated with duration of disease. There was no relation between duration of disease and presence of tendinous disease.

A espondilite anquilosante (EA) é uma doença inflamatória crônica caracterizada por acometimento predominante do esqueleto axial. Ocorre de forma insidiosa e é potencialmente debilitante, levando à redução na qualidade de vida dos indivíduos acometidos. A sua etiopatogenia ainda não está totalmente esclarecida, dificultando estratégias no seu diagnóstico e manejo. O avanço da terapia com agentes biológicos veio reforçar discussões sobre a melhor forma de avaliação destes pacientes. Nesta revisão, discutimos os principais instrumentos utilizados para avaliar pacientes com EA e o consenso do grupo internacional (ASAS working group - Assessments in Ankylosing Spondylitis Working Group) determinado no OMERACT IV (Outcome Measures in Rheumatology).

Ankylosing spondylitis is a chronic and progressive disease involving predominantly the axial skeleton. It is insidious and potentially debilitating, compromising the quality of life of patients suffering from the disease. The etiopathogenesis is still uncertain, which difficult strategies in its diagnosis and treatment. Advances in biological therapies are reforcing discussions in the best way of managing the disease. In this paper, we revise the outcome instruments available for ankylosing spondylitis and the consensus from the ASAS working group (Assessments in Ankylosing Spondylitis Working Group) established at the OMERACT IV (Outcome Measures in Rheumatology).