《2009年銀屑病的傳統(tǒng)的系統(tǒng)治療指南》內(nèi)容預(yù)覽

An evidence-based model was used and evidencewas obtained using a search of the MEDLINE data-base spanning the years 1960 through 2008. OnlyEnglish-language publications were reviewed.The available evidence was evaluated using a uni-fied system called the Strength of RecommendationTaxonomy developed by editors of the US familymedicine and primary care journals (ie, AmericanFamily Physician, Family Medicine, Journal of FamilyPractice, and BMJ USA). This strategy was supported bya decision of the Clinical Guidelines Task Force in 2005with some minor modifications for a consistent ap-proach to rating the strength of the evidence ofscientific studies.Evidence was graded using a 3-point scale based on the quality of methodology asfollows:
I. Good-quality patient-oriented evidence.
II. Limited-quality patient-oriented evidence.
III. Other evidence including consensus guidelines,opinion, or case studies.
Clinical recommendations were developed on thebest available evidence tabled in the guideline.These are ranked as follows:
A. Recommendation based on consistent and good-quality patient-oriented evidence.B. Recommendation based on inconsistent or lim-ited-quality patient-oriented evidence.C. Recommendation based on consensus, opinion,or case studies.
In those situations where documented evidence-based data are not available, we have used expertopinion to generate our clinical recommendations.Prior guidelines on psoriasis were also evaluated.This guideline has been developed in accordancewith the AAD ‘‘Administrative Regulations forEvidence-based Clinical Practice Guidelines,’’ whichinclude the opportunity for review and comment bythe entire AAD membership and final review andapproval by the AAD Board of Directors.
GENERAL PRINCIPLES
In the past, conventional systemic psoriasis ther-apiesemethotrexate, cyclosporine (CSA), andacitretinewere used when psoriasis was too exten-sive for topical therapy or refractory to topical ther-apy and phototherapy. Although a minimum bodysurface area, eg, 10%, has been traditionally used as aprerequisite to starting a systemic therapy for psori-asis, a subset of patients with limited disease havedebilitating symptoms. For example, although severepsoriasis of the palms and soles or severe scalppsoriasis affects less than 5% of the body surfacearea, the significant negative affect on the quality oflife of the patient makes a systemic approach totreatment appropriate.

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