Editorial
Challenges and opportunities for the International League of Associations for Rheumatology (ILAR)
Retos y oportunidades de la Liga Internacional de Asociaciones para la Reumatología (ILAR)
Carlos Pinedaa,b,
Corresponding author
carpineda@yahoo.com
Correspondence to: Chair, International League of Associations for Rheumatology, Mexico.
Correspondence to: Chair, International League of Associations for Rheumatology, Mexico.
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This perception requires the incorporation into current policies of the impact of these conditions on the present and future burden of noncommunicable chronic diseases.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The overall impact of musculoskeletal conditions in terms of disability is also great, as they are the cause of 21.3% of the total years lived with disability, surpassed only by mental and behavioral problems.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In the 50- to 69-year age range, in which individuals still tend to participate in the labor market, musculoskeletal conditions are the major cause of years lived with disability worldwide, with a prevalence of 33% in developed countries and 27% in developing countries.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Among the above-mentioned conditions, rheumatoid arthritis (RA) alone has been classified as the 42nd highest ranking in terms of years lived with disability, just below malaria and just above iodine deficiency.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> In Latin America, medical attention for this disease is further complicated as it faces additional challenges<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0025" class="elsevierStylePara elsevierViewall">competing for limited public funding that is allocated to combating poverty, the lack of education and a growing number of patients, and</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0030" class="elsevierStylePara elsevierViewall">contending with demographic and epidemiologic transitions with an insufficient number of rheumatologists, who are concentrated in large cities. The education and training of health professionals are also unmet priority needs.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p></li></ul></p><p id="par0035" class="elsevierStylePara elsevierViewall">As a result of these circumstances, RA is not considered a public health priority in the national health systems of the region, in which only 56% of the patients with this condition has had access to full medical health coverage (often excluding biological products).<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The drafting of this brief review of the mounting challenges is important because, in the near future, the growth of the population, aging and sedentary lifestyles will translate into a public health crisis in which musculoskeletal conditions, among them RA and osteoarthritis, will become critical components that require, as of now, a coordinated response on the part of multiple systems and actors, both public and private.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Previous efforts to overcome these challenges found in Latin America include the following:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">(1)</span><p id="par0050" class="elsevierStylePara elsevierViewall">the identification of health care barriers,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">(2)</span><p id="par0055" class="elsevierStylePara elsevierViewall">the promotion of access to timely diagnosis and treatment, with the development of algorithms based on these realities,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">(3)</span><p id="par0060" class="elsevierStylePara elsevierViewall">the education of patients and physicians,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">(4)</span><p id="par0065" class="elsevierStylePara elsevierViewall">the estimation of the economic impact of the disease in the region<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> and,</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">(5)</span><p id="par0070" class="elsevierStylePara elsevierViewall">the creation of guidelines to harmonize and standardize the treatment of RA patients through the development of programs focusing on the establishment of networks and centers of excellence.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p></li></ul></p><p id="par0075" class="elsevierStylePara elsevierViewall">Within this scenario, the International League of Associations for Rheumatology (ILAR) lends support to programs that lead to progress in the practice and teaching of rheumatology in developing countries. Its executive committee is made up of presidents and presidents-elect of the Pan-American League of Associations for Rheumatology (PANLAR); the European League Against Rheumatism (EULAR); the African League of Associations for Rheumatology (AFLAR); Asia-Pacific League of Associations for Rheumatology (APLAR, including Australia) and the American College of Rheumatology (ACR), which integrates Canada, the United States and Mexico.</p><p id="par0080" class="elsevierStylePara elsevierViewall">The collaboration among the leaders of these international organizations has translated into a renewed commitment, especially with developing countries. In this respect, the annual ILAR Grants Program is an exceptional funding initiative that was developed in response to the growing need for global advancement in rheumatology in all these nations.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Since its foundation, ILAR has awarded more than US $550,000 to 41 projects around the world. The countries that have benefited from these grants are, among others, the Philippines, Lebanon, Macedonia, Jamaica, Uruguay, Kenya, India, Burundi, Rwanda, Tanzania, Mexico, Zambia, Argentina, Vietnam, Brazil, South Africa, China, Haiti, Namibia, Botswana, Zimbabwe, Cambodia, Ecuador and Ghana.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Among the notable projects, ILAR has promoted initiatives such as a training program in rheumatology in Haiti; programs for training and education in rheumatic diseases for primary care physicians and residents in rural China; the development of programs of community-based rehabilitation for musculoskeletal diseases in low-income areas of Mexico; improvement in the collaboration among rheumatology services in Cambodia; and a joint effort on the part of APLAR and rheumatologists of the Australian Rheumatology Association with physicians from Cambodia, among many others.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Under a new directorate, designated on 11 June 2015, at the EULAR meeting held in the city of Rome, Italy, 3 new high-priority lines were presented with the aim of promoting progress in education and clinical practice in rheumatology in the developing world:<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">(1)</span><p id="par0100" class="elsevierStylePara elsevierViewall">to draw up guidelines for emerging diseases such as, for example, the recognition and treatment of chikungunya virus. ILAR acknowledges that the infectious agents and environmental events may be prolonged and have adverse effects at the musculoskeletal level,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> especially in the poorest countries.</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">(2)</span><p id="par0105" class="elsevierStylePara elsevierViewall">to modify consensus documents such as recommendations for the treatment of the major rheumatic diseases, including practical solutions when the available resources are limited. ILAR acknowledges that the current recommendations and guidelines for treatment are not being applied in certain developing countries and, thus, should be modified on the basis of the best practices actually being applied in those countries.</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">(3)</span><p id="par0110" class="elsevierStylePara elsevierViewall">to generate practical solutions to address problems of storage and distribution of medication for rheumatic diseases in developing countries. ILAR realizes that the biological agents necessary for the treatment of rheumatic diseases have a short half-life, require the maintenance of a cold chain, etc. This may pose logistic difficulties involving transport, storage and distribution in poor countries, which must be taken into account.</p></li></ul></p><p id="par0115" class="elsevierStylePara elsevierViewall">With these 3 new high-priority lines, ILAR hopes to strengthen its mission by fostering greater recognition of the conditions that make it possible to improve musculoskeletal health in less privileged nations, in the understanding that these are problems that sooner or later will have a greater impact on overall public health in those nations.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Pineda C. Retos y oportunidades de la Liga Internacional de Asociaciones para la Reumatología (ILAR). Reumatol Clin. 2015;11:267–268.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Planning and evaluating population interventions to reduce noncommunicable disease risk–reconciling complexity and scientific rigour?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Bauman" 1 => "D. 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Soriano" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/RHU.0000000000000247" "Revista" => array:6 [ "tituloSerie" => "J Clin Rheumatol" "fecha" => "2015" "volumen" => "21" "paginaInicial" => "175" "paginaFinal" => "180" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26010179" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fiebre chikungunya. Manifestaciones reumáticas de una infección emergente en Europa" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.L. Horcada" 1 => "C. Díaz-Calderón" 2 => "L. Garrido" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.reuma.2014.07.005" "Revista" => array:6 [ "tituloSerie" => "Reumatol Clin" "fecha" => "2015" "volumen" => "11" "paginaInicial" => "161" "paginaFinal" => "164" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25192946" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000001100000005/v1_201509041903/S2173574315000982/v1_201509041903/en/main.assets" "Apartado" => array:4 [ "identificador" => "17335" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Editorial" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001100000005/v1_201509041903/S2173574315000982/v1_201509041903/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574315000982?idApp=UINPBA00004M" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 5 | 9 |
| 2024 October | 48 | 26 | 74 |
| 2024 September | 68 | 24 | 92 |
| 2024 August | 65 | 34 | 99 |
| 2024 July | 48 | 25 | 73 |
| 2024 June | 81 | 32 | 113 |
| 2024 May | 50 | 40 | 90 |
| 2024 April | 66 | 25 | 91 |
| 2024 March | 53 | 27 | 80 |
| 2024 February | 34 | 23 | 57 |
| 2024 January | 36 | 16 | 52 |
| 2023 December | 32 | 26 | 58 |
| 2023 November | 46 | 27 | 73 |
| 2023 October | 33 | 32 | 65 |
| 2023 September | 59 | 28 | 87 |
| 2023 August | 40 | 13 | 53 |
| 2023 July | 41 | 42 | 83 |
| 2023 June | 38 | 21 | 59 |
| 2023 May | 52 | 22 | 74 |
| 2023 April | 20 | 11 | 31 |
| 2023 March | 74 | 36 | 110 |
| 2023 February | 41 | 18 | 59 |
| 2023 January | 46 | 15 | 61 |
| 2022 December | 58 | 51 | 109 |
| 2022 November | 62 | 23 | 85 |
| 2022 October | 65 | 33 | 98 |
| 2022 September | 56 | 37 | 93 |
| 2022 August | 43 | 32 | 75 |
| 2022 July | 45 | 34 | 79 |
| 2022 June | 42 | 41 | 83 |
| 2022 May | 47 | 51 | 98 |
| 2022 April | 38 | 50 | 88 |
| 2022 March | 43 | 52 | 95 |
| 2022 February | 39 | 42 | 81 |
| 2022 January | 52 | 31 | 83 |
| 2021 December | 35 | 35 | 70 |
| 2021 November | 49 | 49 | 98 |
| 2021 October | 66 | 38 | 104 |
| 2021 September | 45 | 41 | 86 |
| 2021 August | 57 | 45 | 102 |
| 2021 July | 34 | 28 | 62 |
| 2021 June | 54 | 40 | 94 |
| 2021 May | 59 | 57 | 116 |
| 2021 April | 92 | 87 | 179 |
| 2021 March | 59 | 26 | 85 |
| 2021 February | 56 | 28 | 84 |
| 2021 January | 38 | 17 | 55 |
| 2020 December | 47 | 23 | 70 |
| 2020 November | 32 | 19 | 51 |
| 2020 October | 38 | 25 | 63 |
| 2020 September | 50 | 24 | 74 |
| 2020 August | 32 | 29 | 61 |
| 2020 July | 15 | 24 | 39 |
| 2020 June | 43 | 22 | 65 |
| 2020 May | 36 | 16 | 52 |
| 2020 April | 31 | 14 | 45 |
| 2020 March | 16 | 5 | 21 |
| 2018 May | 4 | 0 | 4 |
| 2018 April | 41 | 8 | 49 |
| 2018 March | 44 | 6 | 50 |
| 2018 February | 28 | 7 | 35 |
| 2018 January | 22 | 7 | 29 |
| 2017 December | 29 | 11 | 40 |
| 2017 November | 30 | 12 | 42 |
| 2017 October | 21 | 8 | 29 |
| 2017 September | 28 | 12 | 40 |
| 2017 August | 34 | 12 | 46 |
| 2017 July | 25 | 11 | 36 |
| 2017 June | 49 | 7 | 56 |
| 2017 May | 50 | 14 | 64 |
| 2017 April | 26 | 10 | 36 |
| 2017 March | 36 | 28 | 64 |
| 2017 February | 15 | 7 | 22 |
| 2017 January | 21 | 12 | 33 |
| 2016 December | 62 | 15 | 77 |
| 2016 November | 52 | 13 | 65 |
| 2016 October | 64 | 12 | 76 |
| 2016 September | 61 | 5 | 66 |
| 2016 August | 55 | 9 | 64 |
| 2016 July | 34 | 6 | 40 |
| 2016 May | 1 | 0 | 1 |
| 2016 January | 1 | 0 | 1 |
| 2015 December | 4 | 34 | 38 |
| 2015 November | 5 | 32 | 37 |
| 2015 October | 14 | 43 | 57 |
| 2015 September | 0 | 31 | 31 |
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