Related Experiment Video
Updated: Jul 30, 2025
Author Spotlight: Self-Assessment Protocol for Predicting Psoriatic Arthritis in Psoriasis Patients
Published on: March 1, 2024
Challenges in the Management of Psoriatic Arthritis in Latin America: A Systematic Review
Andre Lucas Ribeiro1, Larissa Dullius1, Natália Sarzi Sartori1
1Hospital de Clínicas de Porto Alegre, Rheumatology Department, Porto Alegre, Brazil.
Insights
Managing psoriatic arthritis (PsA) in Latin America presents significant challenges, including opportunistic infections and socioeconomic factors impacting patient care. Further research is crucial to address these unique treatment hurdles.
Area of Science:
- Rheumatology
- Public Health
- Health Services Research
Background:
- Psoriatic arthritis (PsA) management recommendations exist but require adaptation for low-income settings.
- Latin America faces a paucity of clinical studies on PsA management.
- This review addresses the need to understand PsA management challenges in Latin America.
Approach:
- A systematic literature review was conducted following PRISMA guidelines.
- Searched PubMed, EMBASE, and LILACS databases (1980-February 2023).
- Included 21 observational studies, primarily from Brazil, analyzing reported management difficulties.
Key Points:
- Opportunistic infections were a significant challenge (42.8% of studies).
- Other difficulties include therapy nonadherence, patient-physician discordance, low drug persistence, and limited access to care.
- Socioeconomic factors profoundly impact work and health outcomes for PsA patients in Latin America.
Conclusions:
- PsA management challenges in Latin America are multifaceted, extending beyond infections to include socioeconomic determinants.
- Improved understanding of regional specificities is essential for enhancing PsA patient care.
- Further research is recommended to address the unique treatment landscape in Latin America.
Purpose:
In 2020, the International League of Associations for Rheumatology published recommendations for managing psoriatic arthritis (PsA), aiming to adapt the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis and the European Alliance of Associations for Rheumatology recommendations to low-income countries. At that time, the paucity of clinical studies examining the management of patients with PsA in Latin America was remarked on by the international working group. Therefore, the primary objective of this systematic literature review was to investigate the main challenges in managing PsA in Latin America as described in recent publications.
Methods:
A systematic literature review of trials reporting at least one challenge/difficulty in the management of PsA in Latin America was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. References published in the PubMed, EMBASE, and LILACS (Latin American and Caribbean Health Sciences Literature) databases between 1980 and February 2023 were included. The selection of references was conducted independently by 2 researchers in the Rayyan Qatar Computing Research Institute program. Two other reviewers independently extracted data. All challenges were noted and categorized into domains. Data analysis was descriptive.
Findings:
The search strategy yielded 2085 references, with 21 studies included in the final analysis. Most studies were conducted in Brazil (66.6%; n = 14) and were observational studies (100%; N = 21). Difficulties faced by PsA patients and physicians included the high incidence of opportunistic infections (described in 42.8% of the publications; n = 9), followed by nonadherence to therapy, discordance between patients and physicians regarding remission rates, low drug persistence, limited access to disease-modifying antirheumatic drugs, issues related to the storage of biologic drugs, elevated cost of biologic drugs, limited access to medical care, diagnostic delay, and the individual- and country-level impact of socioeconomic factors on work- and health-related outcomes.
Implications:
Challenges in the management of PsA in Latin America extend beyond the care of opportunistic infections, encompassing several other socioeconomic factors. More research is needed to better understand the peculiarities of treating PsA in Latin America to improve patient care. PROSPERO identifier: CRD42021228297.
Related Concept Videos
01:21Rheumatic Heart Disease III: Medical Management
01:26Atherosclerosis III: Management
01:29Chronic Obstructive Pulmonary Disease-V: Management
Smoking Cessation
01:26Peripheral Artery Disease IV: Nursing Management
01:20Rheumatic Heart Disease IV: Nursing Management
01:20Asthma: Pathogenesis and Management
Asthma is classified as allergic and non-allergic. Allergens such as dust mites, pollen, and pet dander trigger allergic asthma, while factors like cold air, intense emotions, or exercise can induce non-allergic asthma.