REVIEWARTICLE Proper management of rheumatoid arthritis in Latin America. What the guidelines say?

Abstract To analyze characteristics of clinical practice guide-lines (CPGs) for the management of rheumatoid arthritis (RA) developed in Latin American (LA) countries and to describe the knowledge, use, and barriers for their implementation per-ceived among LA rheumatologists, a comprehensive literature search including Medline, PubMed, Cochrane Library, LI-LACS and Scielo was performed. The Appraisal of Guide-lines for Research and Evaluation (AGREE) instrument was applied for evaluation. A survey was sent to PANLAR mem-bers containing questions related to knowledge about guide-lines, application of the recommendations, and difficulties in implementing CPGs. Eight guidelines were identified. Most guidelines were evidence based (62 %), but in only 37 % a systematic literature search was done. None of the guidelines included patients ’ views and preferences, and only few of them stated an updating procedure. Funding body independence and disclosure of conflicts of interest were rare-ly reported. The survey was answered by 214 rheumatologists from all Latin American countries. Most rheumatologist re-ported knowledge and use of clinical guidelines, mainly inter-national ones. In general, rheumatologist felt that guidelines apply to only a minority of patients seen in daily clinical practice. Limited access expensive drugs, suggested by the guidelines, was the most frequent barrier to guidelines imple-mentation that was reported. A good number of guidelines on the treatment of rheumatoid arthritis have been developed in Latin America. Most of them are lacking some of the compo-nents recognized for high-quality clinical guidelines develop-ment. In spite that most rheumatologist know and apply guide-lines, access to drugs is still a very important barrier to their implementation in Latin America