Pan American League of Associations for Rheumatology recommendations for the management of rheumatoid arthritis.

Abstract

The Pan American League of Associations for Rheumatology has developed evidence-based recommendations for the pharmacological management of rheumatoid arthritis in Latin America. A panel of rheumatoid arthritis experts from Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Mexico, Panama, Peru, Uruguay, and Venezuela formulated clinically relevant questions in the population, intervention, comparator, outcome format. Systematic literature reviews were done following the Grading of Recommendations Assessment, Development and Evaluation method. Recommendations were formulated based on evidence quality and expert consensus, which required at least 70% agreement among the voting members to be included in the guidelines. Ten recommendations and a treatment algorithm were developed. Key topics include early initiation of conventional synthetic disease-modifying antirheumatic drugs (DMARDs), particularly methotrexate, parenteral methotrexate for intolerance, cautious glucocorticoid use, switching mechanisms of action after unsuccessful biological or targeted synthetic DMARD treatment, tapering in remission, and guidance for rheumatoid arthritis-associated interstitial lung disease and vasculitis. Special attention is given to cost-effectiveness and accessibility considering the socioeconomic characteristics of Latin America. These recommendations aim to support clinicians in Latin America by providing a practical, evidence-based, and contextually relevant framework that addresses the unique challenges faced in the region.