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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Psoriatic Arthritis &#40;PsA is a chronic inflammatory disease of the musculoskeletal system belonging to the family of spondyloarthritis&#46; It presents in 30&#37; of patients with platelet psoriasis&#44; particularly in those with nail bed compromise and with location of the psoriasis in certain anatomical areas &#40;e&#46;g&#46; scalp&#41;&#46; It affects between &#46;05&#37; and &#46;25&#37; of the general population&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> which makes it the second most common form of chronic inflammatory arthritis after rheumatoid arthritis&#46; PsA comprises several domains which represent the phenotypic manifestations of the disease&#46; It usually aggravates skin psoriasis and often presents as an oligoarthritis with dactylitis&#44; enthesitis and&#47;or extra-articular-associated axial compromise&#44; which included uveitis and&#47;or inflammatory bowel disease&#46; Its varied forms of presentation and manifestations&#44; both musculoskeletal and cutaneous&#44; make its therapeutic focus hugely complex&#44; often requiring a multidisciplinary approach&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In order to approach the therapeutic options and integrate the musculoskeletal and cutaneous phenotypes&#44; the GRAPPA group &#40;Group for Research and Assessment of Psoriasis and Psoriatic Arthritis&#41; identified six disease domains &#40;peripheral arthritis&#44; enthesitis&#44; dactylitis&#44; axial compromise&#44; psoriasis and nail bed compromise&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Available information in the literature regarding prevalence&#44; incidence&#44; phenotypic presentation and response to treatment in developing countries is scarce&#46; Management recommendations for PsA from GRAPPA<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> and EULAR<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> &#40;European League Against Rheumatism&#41;&#44; have been developed based on information from studies originating from Europe and North America&#46; These recommendations have often been adapted to the context of the health systems and patients in the different developing countries&#46; However&#44; there are no recommendations which specifically focus on the treatment of PsA in countries with limited resources&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Bearing in mind the above&#44; a group of members from the ILAR &#40;International League of Associations for Rheumatology&#41; worked on creating recommendations for the treatment of PsA&#44; in regions of the world where several of the recommended treatments had access limitations or their use was conditioned by the presence of infectious diseases and&#47;or comorbidities&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The group called <span class="elsevierStyleItalic">ILAR-PsA</span> comprised rheumatologists and dermatologists from Latin American and Africa countries with clinical expertise in the treatment of PsA and Psoriasis&#46; The Asia Pacific region was not represented in the group because the APLAR &#40;Asia Pacific League of Associations for Rheumatology&#41; was in the process of writing its own guidelines&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">To adapt the existing GRAPPA and EULAR guidelines&#44; the <span class="elsevierStyleItalic">ILAR-PsA</span> recommendation group used the <span class="elsevierStyleItalic">ADAPTE</span> process for the development of clinical practice guidelines&#46; In order to generate recommendations&#44; they identified specific areas of unmet needs and exclusive challenges pertaining to countries with limited resources&#46; The work group discussed the relevant questions of diagnosis and treatment approach and they reviewed the EULAR and GRAPPA recommendations for clinical content in accordance with the approved questions&#46; Following an iterative process&#44; 10 questions were identified with under 70&#37; agreement between committee members&#44; and this therefore required a systematic review of the literature&#46; Despite an exhaustive review of databases &#40;including&#44; among others&#44; the African Index Medicus&#44; and Latin American and Caribbean Healthcare Literature&#41;&#44; no published information was found to have come from regions with limited resources&#46; The recommendations relating to these questions were therefore adapted based on the expert opinions&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The recommendation group evaluated the need for early diagnosis and the use of disease-modifying drugs &#40;in monotherapy or combined therapy&#41;&#44; to obtain control of the disease in regions with limited access to biologics and with specific comorbidities which would be potentially included in clinical decisions&#46; The importance of monitoring the efficacy and safety of the said drugs was emphasized&#44; including follow-up of adverse events&#46; Equally&#44; patient access limitations were discussed by both speciality healthcare professionals&#44; rheumatologists and dermatologists&#46; Follow-up of comorbidities and the need for a multidisciplinary team to manage a heterogeneous and complex disease was also highlighted&#46; Finally&#44; the prevalence of infections was considered &#40;including tuberculosis&#41;&#44; which is higher in developing countries&#46; However&#44; there is very little information available which evaluates the prevalence of these infections in patients with PsA in these regions&#46; This is relevant in the setting of the use of biologic therapy &#40;e&#46;g&#46; anti TNF&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> as it may increase the risk of active tuberculosis&#46; Other infections include Chagas disease&#44; leishmaniasis&#44; hepatitis B&#44; hepatitis C and leprosy&#46; In these cases&#44; follow-up of national directives were recommended for each of these conditions prior to initiation of treatment&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Several studies have been conducted in Latin America aimed at filling in the information gaps on PsA&#46; Studies have been published which evaluate the epidemiological profile and prevalence of patients with spondyloarthritis including PsA&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Other studies have estimated that the incidence and prevalence may be similar to that reported in Europe and the United States&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> and usage frequency of treatment options in daily clinical practice has been estimated&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Additional studies have also explored the levels of satisfaction given by the doctor and patient with regards to PsA treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">To sum up&#44; the recommendations of the <span class="elsevierStyleItalic">ILAR-PsA</span> group were specifically geared towards region of the world with limited human and economic resources&#46; They provide additional relevant information for the specific environments of these countries and they seek to unify PsA treatment in a complementary fashion to national guidelines of these countries when they are available&#46; We would emphasize the importance of supranational scientific societies such as PANLAR &#40;Pan American League of Associations of Rheumatology&#41; in creating guidelines for PsA management where the particularities of these countries are considered&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">One of the main results from this adaptation exercise was the acknowledgement of the scarcity of information in the context of PsA patients in regions with limited resources&#44; including Latin American&#46; In this sense there is clearly a need to design and produce a research plan to provide relevant data and to identify not only epidemiological aspects &#8212; such as prevalence&#44; extra-articular manifestations&#44; structural damage&#44; comorbidities-&#44; but to also calculate delay in diagnosis&#44; patient perspective&#44; medical outcomes&#44; response to treatment and the safety of pharmacological interventions in patients with PsA&#46; The need also arises for the evaluation of these recommendations&#44; in the light of the recent new evidence arising&#46; We hope this document serves as a wake-up call to rheumatologists&#44; researchers and financial entities in Latin American to recognise these shortcomings and to provide evidence through a research plan so that by fortifying these and future recommendations in PsA any unmet needs may be resolved&#46;</p></span>"
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Editorial
Treatment of psoriatic arthritis: Challenges in Latin America
Tratamiento de la artritis psoriásica: retos y desafíos en Latino América
Wilson Bautista Molano
Hospital Universitario Fundación Santa Fe de Bogotá, Universidad El Bosque, Bogotá, Colombia
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Psoriatic Arthritis &#40;PsA is a chronic inflammatory disease of the musculoskeletal system belonging to the family of spondyloarthritis&#46; It presents in 30&#37; of patients with platelet psoriasis&#44; particularly in those with nail bed compromise and with location of the psoriasis in certain anatomical areas &#40;e&#46;g&#46; scalp&#41;&#46; It affects between &#46;05&#37; and &#46;25&#37; of the general population&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> which makes it the second most common form of chronic inflammatory arthritis after rheumatoid arthritis&#46; PsA comprises several domains which represent the phenotypic manifestations of the disease&#46; It usually aggravates skin psoriasis and often presents as an oligoarthritis with dactylitis&#44; enthesitis and&#47;or extra-articular-associated axial compromise&#44; which included uveitis and&#47;or inflammatory bowel disease&#46; Its varied forms of presentation and manifestations&#44; both musculoskeletal and cutaneous&#44; make its therapeutic focus hugely complex&#44; often requiring a multidisciplinary approach&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In order to approach the therapeutic options and integrate the musculoskeletal and cutaneous phenotypes&#44; the GRAPPA group &#40;Group for Research and Assessment of Psoriasis and Psoriatic Arthritis&#41; identified six disease domains &#40;peripheral arthritis&#44; enthesitis&#44; dactylitis&#44; axial compromise&#44; psoriasis and nail bed compromise&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Available information in the literature regarding prevalence&#44; incidence&#44; phenotypic presentation and response to treatment in developing countries is scarce&#46; Management recommendations for PsA from GRAPPA<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> and EULAR<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> &#40;European League Against Rheumatism&#41;&#44; have been developed based on information from studies originating from Europe and North America&#46; These recommendations have often been adapted to the context of the health systems and patients in the different developing countries&#46; However&#44; there are no recommendations which specifically focus on the treatment of PsA in countries with limited resources&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Bearing in mind the above&#44; a group of members from the ILAR &#40;International League of Associations for Rheumatology&#41; worked on creating recommendations for the treatment of PsA&#44; in regions of the world where several of the recommended treatments had access limitations or their use was conditioned by the presence of infectious diseases and&#47;or comorbidities&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The group called <span class="elsevierStyleItalic">ILAR-PsA</span> comprised rheumatologists and dermatologists from Latin American and Africa countries with clinical expertise in the treatment of PsA and Psoriasis&#46; The Asia Pacific region was not represented in the group because the APLAR &#40;Asia Pacific League of Associations for Rheumatology&#41; was in the process of writing its own guidelines&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">To adapt the existing GRAPPA and EULAR guidelines&#44; the <span class="elsevierStyleItalic">ILAR-PsA</span> recommendation group used the <span class="elsevierStyleItalic">ADAPTE</span> process for the development of clinical practice guidelines&#46; In order to generate recommendations&#44; they identified specific areas of unmet needs and exclusive challenges pertaining to countries with limited resources&#46; The work group discussed the relevant questions of diagnosis and treatment approach and they reviewed the EULAR and GRAPPA recommendations for clinical content in accordance with the approved questions&#46; Following an iterative process&#44; 10 questions were identified with under 70&#37; agreement between committee members&#44; and this therefore required a systematic review of the literature&#46; Despite an exhaustive review of databases &#40;including&#44; among others&#44; the African Index Medicus&#44; and Latin American and Caribbean Healthcare Literature&#41;&#44; no published information was found to have come from regions with limited resources&#46; The recommendations relating to these questions were therefore adapted based on the expert opinions&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The recommendation group evaluated the need for early diagnosis and the use of disease-modifying drugs &#40;in monotherapy or combined therapy&#41;&#44; to obtain control of the disease in regions with limited access to biologics and with specific comorbidities which would be potentially included in clinical decisions&#46; The importance of monitoring the efficacy and safety of the said drugs was emphasized&#44; including follow-up of adverse events&#46; Equally&#44; patient access limitations were discussed by both speciality healthcare professionals&#44; rheumatologists and dermatologists&#46; Follow-up of comorbidities and the need for a multidisciplinary team to manage a heterogeneous and complex disease was also highlighted&#46; Finally&#44; the prevalence of infections was considered &#40;including tuberculosis&#41;&#44; which is higher in developing countries&#46; However&#44; there is very little information available which evaluates the prevalence of these infections in patients with PsA in these regions&#46; This is relevant in the setting of the use of biologic therapy &#40;e&#46;g&#46; anti TNF&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> as it may increase the risk of active tuberculosis&#46; Other infections include Chagas disease&#44; leishmaniasis&#44; hepatitis B&#44; hepatitis C and leprosy&#46; In these cases&#44; follow-up of national directives were recommended for each of these conditions prior to initiation of treatment&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Several studies have been conducted in Latin America aimed at filling in the information gaps on PsA&#46; Studies have been published which evaluate the epidemiological profile and prevalence of patients with spondyloarthritis including PsA&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Other studies have estimated that the incidence and prevalence may be similar to that reported in Europe and the United States&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> and usage frequency of treatment options in daily clinical practice has been estimated&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Additional studies have also explored the levels of satisfaction given by the doctor and patient with regards to PsA treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">To sum up&#44; the recommendations of the <span class="elsevierStyleItalic">ILAR-PsA</span> group were specifically geared towards region of the world with limited human and economic resources&#46; They provide additional relevant information for the specific environments of these countries and they seek to unify PsA treatment in a complementary fashion to national guidelines of these countries when they are available&#46; We would emphasize the importance of supranational scientific societies such as PANLAR &#40;Pan American League of Associations of Rheumatology&#41; in creating guidelines for PsA management where the particularities of these countries are considered&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">One of the main results from this adaptation exercise was the acknowledgement of the scarcity of information in the context of PsA patients in regions with limited resources&#44; including Latin American&#46; In this sense there is clearly a need to design and produce a research plan to provide relevant data and to identify not only epidemiological aspects &#8212; such as prevalence&#44; extra-articular manifestations&#44; structural damage&#44; comorbidities-&#44; but to also calculate delay in diagnosis&#44; patient perspective&#44; medical outcomes&#44; response to treatment and the safety of pharmacological interventions in patients with PsA&#46; The need also arises for the evaluation of these recommendations&#44; in the light of the recent new evidence arising&#46; We hope this document serves as a wake-up call to rheumatologists&#44; researchers and financial entities in Latin American to recognise these shortcomings and to provide evidence through a research plan so that by fortifying these and future recommendations in PsA any unmet needs may be resolved&#46;</p></span>"
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