To the Editor We read with interest the Research Letter by Duarte-García1 and colleagues in a recent issue of JAMA Internal Medicine. As chairs of the American College of Rheumatology (ACR) Quality of Care Committee and Guideline Subcommittee, we welcome critical evaluation of ACR guideline efforts because these efforts help direct guideline development. We agree that high-quality evidence is ideal, but unfortunately, many rheumatic conditions are rare and require complex treatment choices, making it impossible to have sufficient large-scale trials. As Duarte-García and colleagues1 note, integration of such evidence is comparable with guidelines in other subspecialties.
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Caplan L, FitzGerald J. Admitting What We Do Not Know in Rheumatologic Disease—The First Step Toward Learning More. JAMA Intern Med. 2018;178(5):723–724. doi:10.1001/jamainternmed.2018.1251
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