Pan American League of Associations for Rheumatology recommendations for the management of rheumatoid arthritis
- PMID: 41240967
- DOI: 10.1016/S2665-9913(25)00259-0
Pan American League of Associations for Rheumatology recommendations for the management of rheumatoid arthritis
Abstract
The Pan American League of Associations for Rheumatology has developed evidence-based recommendations for the pharmacological management of rheumatoid arthritis in Latin America. A panel of rheumatoid arthritis experts from Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Mexico, Panama, Peru, Uruguay, and Venezuela formulated clinically relevant questions in the population, intervention, comparator, outcome format. Systematic literature reviews were done following the Grading of Recommendations Assessment, Development and Evaluation method. Recommendations were formulated based on evidence quality and expert consensus, which required at least 70% agreement among the voting members to be included in the guidelines. Ten recommendations and a treatment algorithm were developed. Key topics include early initiation of conventional synthetic disease-modifying antirheumatic drugs (DMARDs), particularly methotrexate, parenteral methotrexate for intolerance, cautious glucocorticoid use, switching mechanisms of action after unsuccessful biological or targeted synthetic DMARD treatment, tapering in remission, and guidance for rheumatoid arthritis-associated interstitial lung disease and vasculitis. Special attention is given to cost-effectiveness and accessibility considering the socioeconomic characteristics of Latin America. These recommendations aim to support clinicians in Latin America by providing a practical, evidence-based, and contextually relevant framework that addresses the unique challenges faced in the region.
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Conflict of interest statement
Declaration of interests Several authors of these guidelines, including voting members, have interacted with the pharmaceutical industry, including the manufacturers of some of the drugs mentioned in these recommendations. However, none of the authors received any support or fees directly or indirectly related to, or influencing, the development of these guidelines. DGFA, MLB, NMMZ, GF, and LRB are part of PANLAR Research Unit. NZ is one of the methodologists. Methodologists received support from PANLAR. The rheumatoid arthritis experts did not receive support from PANLAR or any other funding source, including pharmaceutical companies or other agencies, to participate in this work. DGFA, MLB, GF, and NMMZ are part of PANLAR committees. None of the authors received financial support for this project from any entity. CVCU reports research support from Pfizer; speaker fees from Pfizer, Lilly, Jansen, AbbVie, and Amgen; support from Amgen to attend EULAR; and is editor in chief of the Global Rheumatology journal from PANLAR. SC reports speaker fees from Boehringer Ingelheim; and grants for attending meetings from Pfizer, AbbVie, Adium, Boehringer Ingelheim, and FAPASA. MHCR reports speaker fees from AbbVie. GC reports consulting fees from AbbVie, Bago, Biosidus, Bristol Myers Squibb, GSK, Johnson & Johnson, Pfizer, Raffo, and Sandoz; and research support from Pfizer and Johnson & Johnson. DGFA reports speaker fees from AbbVie, Pfizer, Janssen, Boehringer Ingelheim, Lilly, Geoden Richter, and Pharmalab; grants for attending meetings from Pfizer, Boehringer Ingelheim, and Janssen; and sits on advisory boards for GSK, Janssen, Lilly, and AbbVie. RGS reports speaker fees from AbbVie, Novartis, Janssen, Pfizer, Lilly, and Sandoz; and consulting fees from AbbVie and Janssen. AMK reports speaker fees from Organon, AbbVie, Janssen, Lilly, Sandoz, Pfizer, and UCB; and support for attending meetings from Organon, AbbVie, and UCB. YFM reports speaker fees from Janssen. EM reports consulting fees from GSK, Hi Bio, AnaptysBio, Alpine Immunology, AbbVie, Pfizer, Bristol Myers Squibb, Johnson & Johnson, Biogen, and AstraZeneca; speaker fees from AbbVie, MRK Serono, Sanofi, Novartis, Pfizer, GSK, and AstraZeneca; and research support from Roche, AbbVie, Pfizer, GSK, and Lilly. AR reports speaker fees and support for attending meetings from AbbVie. PSM reports research support from Pfizer, Novartis, and Bristol Myers Squibb; speaker fees from Novartis, Amgen, and Janssen; support for attending meetings from Steincare Pharmalab, AbbVie, and Janssen; and sits on advisory boards for Bristol Myers Squibb, Amgen, Biopas, and UCB. ERS reports consulting fees from AbbVie, Amgen, Bristol Myers Squibb, Janssen, Lilly, Novartis, Pfizer, Roche, Sandoz, and UCB; speaker fees from AbbVie, Amgen, Janssen, Lilly, Novartis, Pfizer, Sandoz, and UCB; and support for attending meetings from AbbVie, Amgen, and Pfizer. LS reports speaker fees from Pfizer, AbbVie, Novartis, and Roche. CETG reports consulting fees from AstraZeneca and Janssen; and speaker fees from AbbVie, AstraZeneca, Biopas, Janssen, Pharmalab, and UCB. SV reports speaker fees from Boehringer Ingelheim. RX reports consulting fees from AbbVie, Fresenius Kabi, Hypera, and Janssen; and speaker fees from AbbVie, Janssen, UCB, GSK, AstraZeneca, Lilly, and Pfizer. All other authors declare no competing interests.
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