Date: Sunday, November 5, 2017
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
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.
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.
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.
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.
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 December 10, 2019.
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