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1.
Ann Rheum Dis ; 77(11): 1549-1557, 2018 11.
Artículo en Inglés | MEDLINE | ID: mdl-30045853

RESUMEN

Systemic lupus erythematosus (SLE), a complex and heterogeneous autoimmune disease, represents a significant challenge for both diagnosis and treatment. Patients with SLE in Latin America face special problems that should be considered when therapeutic guidelines are developed. The objective of the study is to develop clinical practice guidelines for Latin American patients with lupus. Two independent teams (rheumatologists with experience in lupus management and methodologists) had an initial meeting in Panama City, Panama, in April 2016. They selected a list of questions for the clinical problems most commonly seen in Latin American patients with SLE. These were addressed with the best available evidence and summarised in a standardised format following the Grading of Recommendations Assessment, Development and Evaluation approach. All preliminary findings were discussed in a second face-to-face meeting in Washington, DC, in November 2016. As a result, nine organ/system sections are presented with the main findings; an 'overarching' treatment approach was added. Special emphasis was made on regional implementation issues. Best pharmacologic options were examined for musculoskeletal, mucocutaneous, kidney, cardiac, pulmonary, neuropsychiatric, haematological manifestations and the antiphospholipid syndrome. The roles of main therapeutic options (ie, glucocorticoids, antimalarials, immunosuppressant agents, therapeutic plasma exchange, belimumab, rituximab, abatacept, low-dose aspirin and anticoagulants) were summarised in each section. In all cases, benefits and harms, certainty of the evidence, values and preferences, feasibility, acceptability and equity issues were considered to produce a recommendation with special focus on ethnic and socioeconomic aspects. Guidelines for Latin American patients with lupus have been developed and could be used in similar settings.


Asunto(s)
Síndrome Antifosfolípido/tratamiento farmacológico , Enfermedades Hematológicas/tratamiento farmacológico , Enfermedades Renales/tratamiento farmacológico , Lupus Eritematoso Sistémico/tratamiento farmacológico , Síndrome Antifosfolípido/etiología , Cardiopatías/tratamiento farmacológico , Cardiopatías/etiología , Enfermedades Hematológicas/etiología , Humanos , Enfermedades Renales/etiología , América Latina , Enfermedades Pulmonares/tratamiento farmacológico , Enfermedades Pulmonares/etiología , Lupus Eritematoso Sistémico/complicaciones , Nefritis Lúpica/tratamiento farmacológico , Nefritis Lúpica/etiología , Trastornos Mentales/tratamiento farmacológico , Trastornos Mentales/etiología , Enfermedades Musculoesqueléticas/tratamiento farmacológico , Enfermedades Musculoesqueléticas/etiología , Enfermedades de la Piel/tratamiento farmacológico , Enfermedades de la Piel/etiología , Nivel de Atención
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