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. 2025 Aug 15:jrheum.2025-0405.
doi: 10.3899/jrheum.2025-0405. Online ahead of print.

Establishing Centers of Excellence for Psoriatic Disease in Latin America: Consensus Recommendations from the REAL-PANLAR Group

Rodrigo Garcia-Salinas  1 , Alexis Ogdie  2 , Fernando Sommerfleck  3 , Enrique R Soriano  4 , Andre L Ribeiro  5 , Verónica Avellanal  6 , Javier Badilla  7 , Antonio Cachafeiro  8 , Juan Raul Castro Ayarza  9 , Nelly Colman  10 , Boris Garro  11 , Sebastián Ibañez Vodnizza  12 , Angela Londoño-Garcia  13 , John Londoño  14 , Daniel Palleiro  15 , Cesar Pacheco-Tena  16 , Carlos Rios  17 , Jossiel Then  18 , Manuel F Ugarte-Gil  19 , Carlo Vinicio Caballero  20 , Paula A Beltran  21 , Pedro Santos-Moreno  22
Affiliations

Establishing Centers of Excellence for Psoriatic Disease in Latin America: Consensus Recommendations from the REAL-PANLAR Group

Rodrigo Garcia-Salinas et al. J Rheumatol. .

Abstract

Objective: Psoriatic Disease (PsD) is a chronic, multisystem inflammatory condition characterized by heterogeneous manifestations, including peripheral arthritis, axial involvement, enthesitis, and cutaneous and nail psoriasis. The condition has significant physical, emotional, and psychosocial impacts on patients. In Latin America, healthcare disparities exacerbate delays in diagnosis and treatment, increasing the burden of PsD and associated comorbidities. This study aimed to establish regionally adapted criteria for Centers of Excellence (CoE) to optimize PsD care.

Methods: A panel of 18 experts in rheumatology and dermatology from 12 Latin American countries developed CoE criteria using the Delphi methodology. A narrative literature review informed the process, and criteria were evaluated using a Likert scale. Consensus was defined as ≥70% agreement. An in-person meeting refined unresolved items. The criteria were categorized into structure, process, and outcomes, based on Donabedian's quality evaluation model.

Results: Two types of CoE were defined: Optimal and Model. Optimal CoEs require a multidisciplinary team including rheumatologists, dermatologists, nurses, and psychologists. Model CoEs expand this team to include gastroenterologists, ophthalmologists, physiatrists, among other specialists. Structural criteria emphasized infrastructure and electronic systems for data management. Process criteria included patient-centered education, multidisciplinary consultations, and psychosocial support. Outcomes focused on standardized clinimetric tools (e.g., PASI, DAPSA) and the "treat-to-target" strategy. Approval ratings ranged from 80% to 100%.

Conclusion: The consensus establishes a framework for CoE in PsD care in Latin America, addressing structural, process, and outcome criteria to improve clinical outcomes, patient satisfaction, and healthcare system sustainability. These standards provide a roadmap for enhancing PsD management in resource-limited settings.

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