Challenges, guidelines, and research priorities
Psoriatic arthritis (PsA), a heterogeneous disease involving multiple domains, can be challenging to manage, particularly in resource-limited settings. With the majority of published research studies in PsA coming from resource-rich countries, guidelines from organizations including the European League Against Rheumatism (EULAR), the American College of Rheumatology (ACR), and the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) are not necessarily applicable to clinical practice in places such as Africa and Latin America, and do not address the unique challenges faced by rheumatologists and other healthcare providers (HCPs) caring for people with PsA in these resource-limited settings.
In early 2020, the International League of Associations for Rheumatology (ILAR) issued some recommendations for PsA management in resource-limited settings based on an adaptation of existing guidelines from GRAPPA and EULAR. The authors highlighted a dearth of evidence to address a number of clinically relevant questions, and proposed research priorities for these settings.
We speak to Vinod Chandran (University of Toronto, Ontario, Canada), lead author on the ILAR guidelines, to gain an understanding of the present issues, and explore some of the particular considerations in specific settings through conversations with specialists who have experience working with PsA patients in Latin America, India, and Africa. Broadly, the issues fall into four main categories:
- access to specialists;
- treatment availability;
- monitoring considerations; and
We also talk to the specialists about the ILAR guidelines, and the current and future research priorities in the different settings.