RESUMO
OBJECTIVE: Psoriatic arthritis (PsA) is chronic disease that compromises multiple domains and might be associated with progressive joint damage, increased mortality, functional limitation, and considerably impaired quality of life. Our objective was to generate evidence-based recommendations on the management of PsA in Pan American League of Associations for Rheumatology (PANLAR) countries. METHODS: We used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE)-ADOLOPMENT approach to adapt the 2019 recommendations of the European Alliance of Associations for Rheumatology. A working group consisting of rheumatologists from various countries in Latin America identified relevant topics for the treatment of PsA in the region. The methodology team updated the evidence and synthesized the information used to generate the final recommendations. These were then discussed and defined by a panel of 31 rheumatologists from 15 countries. RESULTS: Theses guidelines report 15 recommendations addressing therapeutic targets, use of antiinflammatory agents and corticosteroids, treatment with disease-modifying antirheumatic drugs (conventional synthetic, biologic, and targeted synthetic), therapeutic failure, optimization of biologic therapy, nonpharmacological interventions, assessment tools, and follow-up of patients with PsA. CONCLUSION: Here we present a set of recommendations to guide decision making in the treatment of PsA in Latin America, based on the best evidence available, considering resources, medical expertise, and the patient's values and preferences. The successful implementation of these recommendations should be based on clinical practice conditions, healthcare settings in each country, and a tailored evaluation of patients.
Assuntos
Antirreumáticos , Artrite Psoriásica , Reumatologia , Artrite Psoriásica/tratamento farmacológico , Artrite Psoriásica/terapia , Humanos , Antirreumáticos/uso terapêutico , Reumatologia/normas , Sociedades Médicas , América Latina , Medicina Baseada em Evidências , Qualidade de Vida , Anti-Inflamatórios/uso terapêutico , Corticosteroides/uso terapêuticoRESUMO
Se reporta el caso documentado de un varón de 26 años de edad con diagnóstico de lupus eritematoso sistémico (LES) de un año de evolución en quien se demostró ausencia de IgA. La agravación del problema a pesar de las medidas de tratamiento que se describen, condujo a la muerte del paciente. Se discute la posible contribución de la deficiencia de IgA facilitando manifestaciones de hipersensibilidad a medicamentos y se cometa la utilidad de determinar inmunodeficiencia IgA en pacientes con LES para conocer si existe participación de este hecho en el comportamiento clínico