International League of Associations for Rheumatology. Systematic Review of the Literature to Inform Treatment Recommendations for Psoriatic Arthritis in Resource-Poor Countries

Musaab Elmamoun¹, Maria Eraso², Laura C Coates³, Ajesh Maharaj⁴, Vinod Chandran⁵, Ahmed Abogamal⁶, Valderilio F Azevedo⁷, Wilson Bautista-Molano⁸, Alex G. Ortega⁹, Jorge Medina-Rosas^10,11, Fabian Hernandez^12,13, Adma Lima¹⁴, Uyi Ima-Edomwonyi¹⁵, Adeola Ajibade¹⁶, Tarun Narang¹⁷, Olusola Ayanlowo¹⁸, Claudia Goldenstein-Schainberg¹⁹, Roberto Ranza^{20,21,22,23,24,25}, Girish M Mody²⁶, Sueli Carneiro^27,28, Aman Sharma²⁹, Oscar Vega-Hinojosa³⁰, Luis E. Vega³¹, Adewale O Adebajo³² and Sergio Toloza³³, ¹Rheumatology, University of Toronto, Toronto Western Hospital, Toronto, ON, Canada, ²University of Toronto, Toronto Western Hospital, Tornoto, ON, Canada, ³Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences,, Oxford, United Kingdom, ⁴Nelson R. Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa, ⁵Medicine, Krembil Research Institute, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada, ⁶Al-Azhar University, Cairo, Egypt, ⁷Adjunct Professor of Rheumatology, Federal University of Paraná; Brazil, Curitiba, Brazil, ⁸School of Medicine, Universidad Militar Nueva Granada and Rheumatology Department Hospital Militar. Colombia, Bogotá, Colombia, ⁹Virginia Commonwealth University, Richmond, VA, ¹⁰Rheumatology, Universidad de la Sabana, Bogota, Colombia, ¹¹Universidad del Valle, Cali, Colombia, ¹²Universidad del Cauca, Popayan, Colombia, ¹³Universidad de Caldas, Pereira, Colombia, ¹⁴Federação Universidade Regional de Blumenau, Blumenau, Brazil, ¹⁵Internal Medicine, Lagos University Teaching Hospital, Surulere, Nigeria, ¹⁶Obafemi Awolowo University Teaching Hospitals Complex Osun state, Nigeria., Osogbo, Nigeria, ¹⁷Postgraduate Institute of Medical Education and Research, Chandigarh, India, ¹⁸Lagos University Teaching Hospital, Lagos, Nigeria, ¹⁹Universidade de São Paulo, São Paulo, Brazil, ²⁰on behalf of the BiobadaBrasil study group, Sociedade Brasileira de Reumatologia, Uberlandia, Brazil, ²¹Rua Otavio Rodrigues DaCunha, Uberlandia MG, Brazil, ²²Servicio de Reumatología, Universidade Federal de Uberlandia, Uberlandia, Brazil, ²³Reumatologia, Reumatologia, Universidade Federal de Uberlandia, Uberlandia, Brazil, ²⁴Matematica, Matematica, Universidade Federal de Uberlandia, Uberlandia, Brazil, ²⁵Universidade Federal de Uberlandia, Uberlandia MG, Brazil, ²⁶Dept of Rheumatology, University of Kwa Zulu-Natal, Durban, South Africa, ²⁷Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil, ²⁸University of São Paulo, Sao Paulo, Brazil, ²⁹Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India, ³⁰Clínica Reumacenter,, Juliaca, Peru, ³¹Hospita Central Fuerza Aerea Perú, Lima, Peru, ³²University of Sheffield, Sheffield, United Kingdom, ³³Rheumatology, Hospital San Juan Batista, Catamarca, Argentina, Catamarca, Argentina

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: health disparities, psoriatic arthritis and treatment guidlelines

Session Information

Date: Sunday, November 5, 2017

Title: Spondyloarthropathies and Psoriatic Arthritis – Clinical Aspects and Treatment Poster I

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose:

Psoriatic Arthritis (PsA) is a heterogeneous disease which makes management of PsA a challenge. European League Against Rheumatism (EULAR) and the Group for Research and Assessment of Psoriasis and PsA (GRAPPA) updated their respective recommendations for the management of PsA in 2015. However, these recommendations are primarily based on studies conducted in resource replete countries of Europe and North America; they may not necessarily be applicable to PsA patients in countries in Central and South America, Africa and the Asia-Pacific region. Therefore there is a need to adapt the EULAR and GRAPPA recommendations for each of these regions under the auspices of ILAR.

Methods:

1) The ADAPTE process for guideline adaptation was used to assess and adapt the EULAR and GRAPPA treatment recommendations for PsA. Guideline quality was assessed using the 23 criteria of the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument.

2) A literature search included three databases Medline, Embase, LILACS to identify studies that addressed additional treatment issues in Central and South America, Africa and the Asia-Pacific region.

Results:

The setup phase of the ADAPTE process was completed. Key health professionals in Pan-American League of Associations for Rheumatology (PANLAR) and The African League of Associations in Rheumatology (AFLAR) as well as patient research-partners identified key health issues faced. The adaptation phase of the ADAPTE process was carried out with both EULAR and GRAPPA recommendations assessed for quality and relevance to ILAR regions. Three different categories were assessed in the two guidelines; a) efficacy and safety of pharmacotherapy, b) recommendation for physicians with limited access to other specialists, c) screening and management of tuberculosis (TB), hepatitis B/C, human immunodeficiency virus (HIV), Chagas’ disease, leishmaniasis, and leprosy. The consensus (> 75% of votes) was to adapt the GRAPPA guidelines in terms of recommendations regarding efficacy and safety of pharmacotherapy, however, recommendations for combination therapy with conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) and biologic (b)DMARDs was not stated and evidence needed to be synthesized from literature review. Similarly, recommendation for biosimilars, biomimics; physicians with limited access to specialists; screening and management of TB, HB/C, HIV, Chagas’ disease, leishmaniasis, was lacking and referred to literature review.

The literature search retrieved a total of 634 articles; following exclusion of duplicates and off-topic items and after title and abstract review 26 articles were included for full text review. Results from the literature review suggests lack of recommendation/evidence around use of biosimilas/biomimics, skin treatment in the absence of dermatologist, and issues around screening and management of certain diseases relevant to resource-poor countries.

Conclusion:

New ILAR recommendations have been devised using adaptation from the GRAPPA recommendations where appropriate and additional SLR data to answer specific issues for resource poor settings and devise a research agenda for these regions.

Disclosure: M. Elmamoun, None; M. Eraso, None; L. C. Coates, None; A. Maharaj, None; V. Chandran, None; A. Abogamal, None; V. F. Azevedo, None; W. Bautista-Molano, None; A. G. Ortega, None; J. Medina-Rosas, None; F. Hernandez, None; A. Lima, None; U. Ima-Edomwonyi, None; A. Ajibade, None; T. Narang, None; O. Ayanlowo, None; C. Goldenstein-Schainberg, None; R. Ranza, None; G. M. Mody, None; S. Carneiro, None; A. Sharma, None; O. Vega-Hinojosa, None; L. E. Vega, None; A. O. Adebajo, None; S. Toloza, None.

To cite this abstract in AMA style:

Elmamoun M, Eraso M, Coates LC, Maharaj A, Chandran V, Abogamal A, Azevedo VF, Bautista-Molano W, Ortega AG, Medina-Rosas J, Hernandez F, Lima A, Ima-Edomwonyi U, Ajibade A, Narang T, Ayanlowo O, Goldenstein-Schainberg C, Ranza R, Mody GM, Carneiro S, Sharma A, Vega-Hinojosa O, Vega LE, Adebajo AO, Toloza S. International League of Associations for Rheumatology. Systematic Review of the Literature to Inform Treatment Recommendations for Psoriatic Arthritis in Resource-Poor Countries [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/international-league-of-associations-for-rheumatology-systematic-review-of-the-literature-to-inform-treatment-recommendations-for-psoriatic-arthritis-in-resource-poor-countries/. Accessed .

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