title: Proper management of rheumatoid arthritis in Latin America. What the guidelines say?
abstract: To analyze characteristics of clinical practice guidelines (CPGs) for the management of rheumatoid arthritis (RA) developed in Latin American (LA) countries and to describe the knowledge, use, and barriers for their implementation perceived among LA rheumatologists, a comprehensive literature search including Medline, PubMed, Cochrane Library, LILACS and Scielo was performed. The Appraisal of Guidelines for Research and Evaluation (AGREE) instrument was applied for evaluation. A survey was sent to PANLAR members containing questions related to knowledge about guidelines, application of the recommendations, and difficulties in implementing CPGs. Eight guidelines were identified. Most guidelines were evidence based (62 %), but in only 37 % a systematic literature search was done. None of the guidelines included patients' views and preferences, and only few of them stated an updating procedure. Funding body independence and disclosure of conflicts of interest were rarely reported. The survey was answered by 214 rheumatologists from all Latin American countries. Most rheumatologist reported knowledge and use of clinical guidelines, mainly international ones. In general, rheumatologist felt that guidelines apply to only a minority of patients seen in daily clinical practice. Limited access expensive drugs, suggested by the guidelines, was the most frequent barrier to guidelines implementation that was reported. A good number of guidelines on the treatment of rheumatoid arthritis have been developed in Latin America. Most of them are lacking some of the components recognized for high-quality clinical guidelines development. In spite that most rheumatologist know and apply guidelines, access to drugs is still a very important barrier to their implementation in Latin America.
authors.affiliation: Rheumatology Unit, Hospital de Clinicas de Porto Alegre, Rio Grande do Sul, Brazil.|Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil.
authors.forename: Claiton V
authors.initials: CV
authors.lastname: Brenol
authors.affiliation: Unidad de Investigación en Epidemiologia Clínica, UMAE Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalara, Mexico.|Programas de Doctorado en Salud Publica y Farmacologia, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico.
authors.forename: Jorge Ivan Gamez
authors.initials: JI
authors.lastname: Nava
authors.affiliation: Rheumatology Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires, Peron 4190, (1180), Buenos Aires, CABA, Argentina. enrique.soriano@hospitalitaliano.org.ar.|Instituto Universitario, Hospital Italiano de Buenos Aires, Peron 4190, (1180), Buenos Aires, CABA, Argentina. enrique.soriano@hospitalitaliano.org.ar.
authors.forename: Enrique R
authors.initials: ER
authors.lastname: Soriano
mesh_terms: D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D019468:Disease Management; D019317:Evidence-Based Medicine; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007843:Latin America; D017410:Practice Guidelines as Topic / Q000592:standards*; D012955:Societies, Medical
keywords: Clinical guidelines; Treatment rheumatoid arthritis