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Estamos comemorando dois anos do lançamento oficial da Global Rheumatology, uma nova revista científica da PANLAR. Neste período, a nascente publicação consolidou a sua política editorial com características diferenciadas que atendem às necessidades de promoção e difusão do conhecimento da comunidade reumatológica mundial e, em especial, da América Latina

We are celebrating two years of officially launching Global Rheumatology, the new scientific journal for PANLAR. During this time, the emerging publication has consolidated its editorial policy with differential characteristics that meet the needs of promotion and communication of knowledge of the rheumatology community worldwide, especially in Latin America.

Estamos cumpliendo dos años de haber lanzado oficialmente Global Rheumatology, una nueva revista científica para PANLAR. Durante este tiempo, la naciente publicación ha consolidado su política editorial con unas características diferenciales que atienden las necesidades de promoción y difusión del conocimiento de la comunidad reumatológica mundial, y en especial la de América Latina.

Background/objective The Latin American population living with lupus lacks reliable and culturally competent health education resources. We describe a Spanish and Portuguese online program to educate Latin American people about lupus. Methods An extensive network of Latin American stakeholders participated in the program design, implementation, dissemination, and evaluation. Patients and rheumatologists selected core topics. Rheumatologists prepared the content using evidence-based data. Adaptations were conducted to meet the audience's health literacy and cultural values. Social media was used to post audiovisual resources and facilitate users' interactions with peers and educators, and a Web site was created to offer in-depth knowledge. Results The most massive outreach was through Facebook, with more than 20 million people reached and 80,000 followers at 3 months, between the Spanish and Portuguese pages. Nearly 90% of followers were from Latin America. A high engagement and positive responses to a satisfaction survey indicate that Facebook users valued these resources. The Spanish and Portuguese Web sites accumulated more than 62,000 page views, and 71.7% of viewers were from Latin American. Conclusions The engagement of patients and stakeholders is critical to provide and disseminate reliable lupus education. Social media can be used to educate and facilitate interactions between people affected by lupus and qualified health care professionals. Social media-based health education has extensive and scalable outreach but is more taxing for the professional team than the Web site. However, the Web site is less likely to be used as a primary education source by Latin American people because they value social interactions when seeking lupus information.

Los autores realizan un análisis sobre la situación actual de las revistas científicas colombianas, el impacto del nuevo modelo de clasificación de revistas científicas de Publindex-Colciencias, su relación con los principios del Manifiesto de Leiden. Hacen mención del uso de las nuevas tecnologías y redes sociales en la comunicación científica.

La Unesco adoptó a finales de noviembre pasado el primer marco internacional sobre Ciencia Abierta. Este documento fue firmado por la totalidad de los 193 países presentes en la 40ta Conferencia General del organismo que busca hacer más transparentes y accesibles los hallazgos científicos.

No final do novembro passado, a UNESCO adotou o primeiro marco internacional sobre Ciência Aberta. Este documento foi assinado por todos os 193 países presentes na 40ª Conferência Geral desta organização que busca tornar as descobertas científicas mais transparentes e acessíveis.

At the end of last November, UNESCO adopted the first international framework on Open Science. This document was signed by all 193 countries present at the 40th General Conference of the organization, which aims to improve the transparency and accessibility of scientific findings

Rheumatic diseases are a reason for frequent consultation with primary care doctors. Unfortunately, there is a high percentage of misdiagnosis.To design an algorithm to be used by primary care physicians to improve the diagnostic approach of the patient with joint pain, and thus improve the diagnostic capacity in four rheumatic diseases.Based on the information obtained from a literature review, we identified the main symptoms, signs, and paraclinical tests related to the diagnosis of rheumatoid arthritis, spondyloarthritis with peripheral involvement, systemic lupus erythematosus with joint involvement, and osteoarthritis. We conducted 3 consultations with a group of expert rheumatologists, using the Delphi technique, to design a diagnostic algorithm that has as a starting point "joint pain" as a common symptom for the four diseases.Thirty-nine rheumatologists from 18 countries of Ibero-America participated in the Delphi exercise. In the first consultation, we presented 94 items to the experts (35 symptoms, 31 signs, and 28 paraclinical tests) candidates to be part of the algorithm; 74 items (25 symptoms, 27 signs, and 22 paraclinical tests) were chosen. In the second consultation, the decision nodes of the algorithm were chosen, and in the third, its final structure was defined. The Delphi exercise lasted 8 months; 100% of the experts participated in the three consultations.We present an algorithm designed through an international consensus of experts, in which Delphi methodology was used, to support primary care physicians in the clinical approach to patients with joint pain. Key Points • We developed an algorithm with the participation of rheumatologists from 18 countries of Ibero-America, which gives a global vision of the clinical context of the patient with joint pain. • We integrated four rheumatic diseases into one tool with one common symptom: joint pain. It is a novel tool, as it is the first algorithm that will support the primary care physician in the consideration of four different rheumatic diseases. • It will improve the correct diagnosis and reduce the number of paraclinical tests requested by primary care physicians, in the management of patients with joint pain. This point was verified in a recently published study in the journal Rheumatology International (reference number 31).

Rheumatic and musculoskeletal diseases (RMDs for its acronym in English), are chronic pathologies of high morbidity with a great impact in quality of life, which generate disability and increase the costs of care. In Latin America there are multiple barriers to patient care. The objective of the study was to identify the care needs and difficulties that patients with RMDs face in the region.

As Doenças reumáticas e musculoesqueléticas (DsRM por sua sigla em português) são patologias crônicas de alta morbidade com grande impacto na qualidade de vida,que geram incapacidades e aumentam os custos do atendimento. Na América Latina, existem várias barreiras para o atendimento ao paciente. O objetivo do estudo foi identificar as necessidades de cuidado e as dificuldades enfrentadas por pacientes com DsRM na região.

The Spanish version of the Educational Needs Assessment Tool (SpENAT), is a self-completed questionnaire that assesses the educational needs (ENs) in osteoarthritis (OA) patients, with the purpose of providing tailored and patient-centered information. This study established the sources of information that patients use and to evaluate the ENs of patients with knee osteoarthritis (KOA) using the SpENAT.

El Educational Needs Assessment Tool-versión española (SpENAT) es un cuestionario que evalúa las necesidades educativas (NE) de pacientes. Este estudio estableció las fuentes de información que los pacientes utilizan y evalúa las NE de pacientes con OA de rodilla utilizando el SpENAT.

Biologics have improved the treatment of rheumatic diseases, resulting in better outcomes. However, their high cost limits access for many patients in both North America and Latin America. Following patent expiration for biologicals, the availability of biosimilars, which typically are less expensive due to lower development costs, provides additional treatment options for patients with rheumatic diseases. The availability of biosimilars in North American and Latin American countries is evolving, with differing regulations and clinical indications. The objective of the study was to present the consensus statement on biosimilars in rheumatology developed by Pan American League of Associations for Rheumatology (PANLAR). Using a modified Delphi process approach, the following topics were addressed: regulation, efficacy and safety, extrapolation of indications, interchangeability, automatic substitution, pharmacovigilance, risk management, naming, traceability, registries, economic aspects, and biomimics. Consensus was achieved when there was agreement among 80% or more of the panel members. Three Delphi rounds were conducted to reach consensus. Questionnaires were sent electronically to panel members and comments about each question were solicited. Eight recommendations were formulated regarding regulation, pharmacovigilance, risk management, naming, traceability, registries, economic aspects, and biomimics. The recommendations highlighted that, after receiving regulatory approval, pharmacovigilance is a fundamental strategy to ensure safety of all medications. Registries should be employed to monitor use of biosimilars and to identify potential adverse effects. The price of biosimilars should be significantly lower than that of reference products to enhance patient access. Biomimics are not biosimilars and, if they are to be marketed, they must first be evaluated and approved according to established regulatory pathways for novel biopharmaceuticals. • Biologics have improved the treatment of rheumatic diseases. • Their high cost limits access for many patients in both North America and Latin America. • Biosimilars typically are less expensive, providing additional treatment options for patients with rheumatic diseases. • PANLAR presents its consensus on biosimilars in rheumatology

Background/Historical PerspectiveAvailability of biologic disease-modifying antirheumatic drugs (bDMARDs) has improved clinical outcomes in rheumatoid arthritis, but it also increased the cost of treatment. Biosimilars, the regulated copies of biologic products, have a potential to reduce health car

Las métricas son herramientas que permiten evaluar el impacto de los productos de investigación. Se clasifican en tradicionales y no tradicionales, las primeras enfocadas en el número de citas, mientras que las ultimas se enfocan en el análisis de tendencias de las publicaciones o trazabilidad digital. Las métricas tradicionales y no tradicionales se complementan entre sí, cada una cumpliendo diferentes roles y propósitos, permitiendo un análisis del desempeño de las publicaciones a corto y largo plazo.

La vacunación contra el covid-19 es la respuesta más importante que está dando la ciencia a la amenaza global que ha representado la pandemia. En la primera parte revisamos la seguridad y eficacia de las vacunas. Esta segunda parte incluye las consideraciones especiales en pacientes con enfermedades reumáticas autoinmunes teniendo en cuenta la necesidad de tener pacientes y médicos informados para la toma de decisiones compartidas. Este artículo surge como respuesta al compromiso de PANLAR*, su comité ejecutivo y de Global Rheumatology en mantener a nuestros miembros y a la comunidad al tanto de las eventualidades más recientes con relación al covid-19 con la idea de poder contribuir a la toma de decisiones médico-paciente.

La vacunación contra el covid-19 es la respuesta más importante que está dando la ciencia a la amenaza global que ha representado la pandemia. Este artículo especial de vacunación y enfermedades reumáticas tiene dos partes. En la primera parte se revisarán los aspectos relevantes de la seguridad y eficacia de las vacunas y en la segunda parte las consideraciones especiales en pacientes con enfermedades reumáticas autoinmunes teniendo en cuenta la necesidad de tener pacientes y médicos informados para la toma de decisiones compartidas. Estos artículos especiales surgen como respuesta al compromiso de PANLAR*, su consejo directivo y de Global Rheumatology en mantener a nuestros miembros y a la comunidad al tanto de las eventualidades más recientes con relación al covid-19 con la idea de poder contribuir a la toma de decisiones médico-paciente.

"Las enfermedades reumáticas y musculoesqueléticas (ERyMEs por sus siglas en español), son patologías crónicas de alta morbilidad con gran impacto en la calidad de vida, que generan discapacidad e incremento en los costos de atención médica. En latinoamérica hay múltiples barreras frente al cuidado del paciente. El objetivo de este estudio fue el identificar las necesidades de atención y dificultades que enfrentan los pacientes con ERyMEs en la región."

Con este proyecto intentamos cubrir algunas brechas en la difusión del conocimiento científico, como la falta de impacto de las publicación fuera de los escenarios exclusivamente académicos, evitar la dependencia exclusiva de las citaciones e impulsar unas métricas que sean adecuadas para el siglo XXI.

Creemos que la divulgación a través del magazíne será un soporte fundamental para la revista científica y un complemento que a nuestro juicio es novedoso y diferencial en el mundo de las publicaciones científicas, pues permitirá conocer con detalle los aportes de la comunidad de científicos de PANLAR a la reumatología global y tener una mirada amplia de las tendencias de la especialidad

Health education is fundamental in the management of RA patients. This study explored patient needs for educational material appropriate for RA patients in our region through a website. This study includes seven focus groups and semi-structured interviews across 4 countries (Argentina, Chile, Colombia, and Mexico) with 71 RA patients. Transcripts were analyzed by anthropologists using qualitative analysis (QA), resulting in themes and subthemes to be developed. Five themes and over 50 subthemes of interest were identified by patients. Grouped into categories as follows: (1) knowing the disease, (2) living with arthritis, (3) treatment and therapies for RA, (4) psychosocial support, and (5) information for families. A response was written by the team in plain Spanish on patient subthemes of interest including additional areas that the team considered relevant. Three videos for YouTube were produced: on patient-doctor relationships, patients at work, and home and at the clinic. Illustrations in a comic book format on RA diagnosis were created. The educational site on RA of PANLAR can be found at htpp://artritisreumatoide.cl. This project accomplished a comprehensive list of RA patient interests, revealing the complex relationship between the information on the disease, the experience of a chronic disease, and the way in which patients approach, conceive, and manage their disease. We expect to gather information on how the website will be used in the future for patients and their families and maintain and improve the website as well as adapt its content to different socioeconomic realities.

The implementation of excellence centers in specific diseases has been gaining recognition in the field of health; specifically in rheumatoid arthritis, where the prognosis of the disease is related to an early diagnosis and a timely intervention, it is necessary that the provision of health services is developed in an environment of quality, opportunity, and safety with the highest standards of care. A methodology that allows this implementation in such a way that is achievable by the most of the care centers is a priority to achieve a better attention to populations with this disease. In this paper, we propose a systematic and progressive methodology that will help all the institutions to develop successful models without faltering in the process. The expected impact on public health is defined by a better effective coverage of high-quality treatments, obtaining better health outcomes with safety and accessibility that reduces the budgetary impact for the health systems of our countries.

With the increases in and aging of the populations of the Americas, monitoring the number of rheumatologists is critical to address and focus on areas of greatest need.The aim of this study was to gather data on the rheumatology workforce from 21 national societies in the Pan American League of Associations for Rheumatology (PANLAR).In September and October 2012 and again in October and November 2015, the heads of the 21 rheumatology national societies were contacted in the 2012 survey; all national societies responded except Cuba. In the 2015 survey, all responded except Nicaragua, for which information was provided by national society presidents in adjacent countries.The data from 21 societies contained in PANLAR consist of 10,166 adult and 678 pediatric rheumatologists serving 961 million people. The number of rheumatologists per 100,000 population varies greatly from 3.9 per 100,000 people (Uruguay) to 0.11 per 100,000 people (Nicaragua). The number of training programs also varies widely, with some countries having no indigenous programs. The distribution of rheumatologists is mainly in the large cities, particularly in the smaller countries. Pediatric rheumatologists have dramatically increased in number in 2012, but 96% reside in 6 countries. This remains an underserved area in most countries.The rheumatology workforce in the Americas has improved between 2012 and 2015, especially in the number of pediatric rheumatologists. However, numerically and in the perception of the 21 member societies of PANLAR, the number is still inadequate to meet the increasing demands for rheumatologic care, especially in the care of children with rheumatic disease and in rural areas.

Resume Objectif Comparer les benefices a court terme des infiltrations de corticoides realisees « a l’aveugle » versus « sous controle echographique », dans le traitement de la tenosynovite chez les patients atteints d’arthrite chronique et determiner si l’infiltration echoguidee est un geste moins douloureux et si des differences existent en termes de modifications de l’aspect echographique au cours du suivi post-injection. Methodes Ont ete inclus dans cette etude des patients qui presentaient une tenosynovite justifiant un traitement par corticoides injectables. Apres l’evaluation clinique et l’etude echographique prealables, les patients ont ete randomises pour faire l’objet d’une infiltration dite « a l’aveugle » ou d’un geste echoguide. L’efficacite de la procedure avait pour critere l’amelioration des scores Health Assessment Questionnaire (HAQ) et des scores echelle visuelle analogique (EVA) douleur qui incluaient le score EVA douleur procedure, EVA douleur globale et EVA douleur locale, mesures a la 1re et la 4e semaine post-injection. Les observations rapportees durant la surveillance echographique en mode Doppler puissance (DP) et en mode B ont egalement fait l’objet du suivi. Les infiltrations a l’aveugle et echoguidees d’une solution contenant 20 mg d’acetate de methylprednisolone ont ete realisees dans des conditions d’asepsie rigoureuses et conformement aux recommandations locales. Resultats Au total, 114 patients ont ete assignes de maniere aleatoire au groupe des infiltrations a l’aveugle (54 patients) ou celui des infiltrations echoguidees (60 patients). Il n’existait initialement aucune difference significative en termes de sexe, d’âge et de duree de la douleur entre les deux groupes. L’infiltration sous controle echographique s’est averee nettement moins douloureuse que le geste realise a l’aveugle (p = 0,0001). L’analyse de l’aire sous la courbe (ASC) a retrouve une meilleure reponse therapeutique au cours du suivi sur la base des scores HAQ, EVA douleur locale et EVA douleur globale (respectivement p = 0,0001, p = 0,012 et p = 0,0001) dans le groupe des infiltrations echoguidees par rapport au geste realise a l’aveugle. Pendant la duree du suivi, une reduction plus marquee des scores en mode DP a ete observee dans le groupe echoguide compare au groupe a l’aveugle (p = 0,0002) sans qu’il y ait de difference statistique constatee entre les deux gestes en mode B (p = 0,5627). Conclusion Notre etude a mis en evidence l’apport benefique significativement superieur des infiltrations echoguidees par rapport aux gestes realises a l’aveugle dans la prise en charge des tenosynovites douloureuses, comme l’indiquent les meilleurs resultats obtenus a court terme et mesures par les scores fonctionnels, cliniques et echographiques. Ces donnees confirment l’interet des infiltrations echoguidees dans le traitement de la tenosynovite en pratique rhumatologique hospitaliere et/ou privee.

At the end of 2013, the Pan American Health Organization issued an epidemiological alert due to the detection of the first local cases of Chikungunya in the Americas. By August 2015, autochthonous transmissions were detected in 33 countries and territories of the Americas. Latin America has reported nearly one million cases; only Colombia has issued a report of >200,000 cases during the first 4 months of 2015. In some Latin American and Caribbean countries, Chikungunya becomes a major public health problem. The disease commonly exhibits a self-limited course of arthritis, usually lasting for a few days or that may be prolonged to weeks; however, in 10–60 % of cases, joint pain may become chronic and persist for up to 3–5 years. Human-caused environmental changes, such as climate change, the globalization of international exchange, and disordered urban growth, are some factors that aid in its emergence and dissemination. Outbreaks of Chikungunya comprise a challenge for health care systems and rheumatologists because of the high attack rate on the population and the anticipated development of post-Chikungunya chronic rheumatism. This review emphasizes the rheumatologic clinical manifestations reported in the American continent and highlights the challenges that health care systems face in the absence of an effective vaccine and specific treatment to fight Chikungunya.

To identify baseline predictors of remission and low disease activity (LDA) in early rheumatoid arthritis (RA) from the GLADAR (Grupo Latino Americano De estudio de la Artritis Reumatoide) cohort.Patients with 1- and 2-year follow-up visits were included. Remission and LDA were defined by DAS28-ESR ( 2.6 and ≤ 3.2, respectively). Baseline predictors examined were gender, ethnicity, age at diagnosis, socioeconomic status, symptoms' duration, DMARDs, RF, thrombocytosis, anemia, morning stiffness, DAS28-ESR (and its components), HAQ-DI, DMARDs and corticosteroid use, and Sharp-VDH score. Multivariable binary logistic regression models (excluding DAS28-ESR components to avoid over adjustment) were derived using a backward selection method (α-level set at 0.05).Four hundred ninety-eight patients were included. Remission and LDA/remission were met by 19.3% and 32.5% at the 1-year visit, respectively. For the 280 patients followed for 2 years, these outcomes were met by 24.3% and 38.9%, respectively. Predictors of remission at 1 year were a lower DAS28-ESR (OR 1.17; CI 1.07-1.27; p = 0.001) and HAQ-DI (OR 1.48; CI 1.04-2.10; p = 0.028). At 2 years, only DAS28-ESR (OR 1.40; CI 1.17-1.6; p 0.001) was a predictor. Predictors of LDA/remission at 1 year were DAS28-ESR (OR 1.42; CI 1.26-1.61; p 0.001), non-use of corticosteroid (OR 1.74; CI 1.11-2.44; p = 0.008), and male gender (OR 1.77; CI 1.2-2.63; p = 0.036). A lower baseline DAS28-ESR (OR 1.45; CI 1.23-1.70; p 0.001) was the only predictor of LDA/remission at 2 years.A lower disease activity consistently predicted remission and LDA/remission at 1 and 2 years of follow-up in early RA patients from the GLADAR cohort. Key Points • In patients with early RA, a lower disease activity at first visit is a strong clinical predictor of achieving remission and LDA subsequently. • Other clinical predictors of remission and LDA to keep in mind in these patients are male gender, non-use of corticosteroids and low disability at baseline. • Not using corticosteroids at first visit is associated with a lower disease activity and predicts LDA/remission at 1 year in these patients.

Background/Objective Although mortality rates related with chikungunya (CHIK) outbreaks in Latin America's (LA's) dengue-endemic rural and new urban regions are low, dealing with symptoms and sequelae can both produce a significant burden of disease and diminish quality of life-from many months to years-after the acute phase of the infection, with a significant impact on public and individual health. The aim of this work was to establish Pan-American League of Associations for Rheumatology-Central American, Caribbean and Andean Rheumatology Association (ACCAR) consensus-conference endorsements and recommendations on the diagnosis and treatment of CHIK-related inflammatory arthropathies transmitted by Aedes aegypti and Aedes albopictus in LA. Methods Based on the Consensus Development Conference format, a panel of ACCAR rheumatologist voting members (n = 10) took part in this Pan-American League of Associations for Rheumatology initiative. Experts voted from a previous content analysis of the medical literature on CHIK, 4 subsequent topic conferences, and a workshop. Consensus represents the majority agreement (≥80%) achieved for each recommendation. Results The experts' panel reached 4 overarching principles: (1) CHIK virus (CHIKV) is a re-emergent virus transmitted by 2 species of mosquitoes: A. aegypti and A. albopictus; (2) CHIKV caused massive outbreaks in LA; (3) chronic CHIKV infection produces an inflammatory joint disease that, in some cases, can last for several months to years, and (4) currently, there are no vaccines or antivirals licensed for CHIKV infections. Recommendations Pan-American League of Associations for Rheumatology-ACCAR achieved 13 endorsements and recommendations on CHIK categorized in 3 groups: (1) epidemiology and clinical manifestations, (2) diagnosis, and (3) treatment, representing the consensus agreement from the panel's members.

Background Although mortality rates related with Chikungunya (CHIK) outbreaks into Latin America’s endemic-dengue rural and new urban regions are low, dealing with symptoms and sequelae can produce both a significant burden of disease and diminish quality of life — from many months to years — after the acute phase of infection, with a significant impact on public and individual health. Objectives The aim of this work was to establish a PANLAR-ACCAR consensus on diagnosis and treatment of CHIK-related inflammatory arthropathies transmitted by Ae. Aegypti and Ae. Albopictus in Latin America (LA). Methods Based on the Consensus Development Conference format, a panel of ACCAR rheumatologists (n=10) took part in this PANLAR initiative. Experts voted recommendations from a previous content analysis of the medical literature on CHIK, four subsequent topic’s Conferences and a workshop. Consensus represents the majority agreement (≥80%) achieved for each recommendation. Results The panel reach four overarching principles: 1) CHIK virus (CHIKV) is a re-emergent virus transmitted by two species of mosquitoes: Ae. Aegypti and Ae. Albopictus; 2) CHIKV caused massive outbreaks in LA; 3) Chronic CHIKV infection produces an inflammatory joint disease that in some cases can last several months to years, and 4) Currently, there are no vaccines or antivirals available for CHIKV infections. Conclusions PANLAR-ACCAR achieve 13 recommendations on CHIK categorised in three groups: 1) epidemiology and clinical manifestations; 2) diagnosis, and 3) treatment, representing the consensus agreement from the panel’s members. References [1] Pineda C, Munoz-Louis R, Caballero-Uribe CV, Viasus D. Chikungunya in the region of the Americas. A challenge for rheumatologists and health care systems. Clin Rheumatol2016;35(10):2381–5. [2] Fernandez-Salas I, Danis-Lozano R, Casas-Martinez M, Ulloa A, Bond JG, Marina CF, et al. Historical inability to control Aedes aegypti as a main contributor of fast dispersal of chikungunya outbreaks in Latin America. Antiviral Res2015;124:30–42. [3] Khoury VJ, Camilo PR. Chikungunya virus (CHIKV): what can be expected after the acute phase?Reumatol Clin2016;12(1):1–3. [4] JC Rueda, J-I Angarita, AM Santos, E-L Saldarriaga, I Pelaez-Ballestas, MJ Soares-Santeugini, J Londono. SAT0576 [5] Improved clinical scenario for chikungunya diagnosis Annals of the Rheumatic Diseases2017Jun;76(Suppl 2):994. Disclosure of Interest None declared

BACKGROUND By 2015, the World Health Organization reported that 1% of the world population suffered from rheumatoid arthritis (RA) and in Latin America (LA) between 0.5% and 1%. Previously, in May 2014, a consensus meeting was held in Barranquilla, Colombia, where the Project for Implementation and Accreditation of Centers of Excellence (CoE) in RA in LA was established, which then became an official special group of the Pan American League of Associations for Rheumatology (PANLAR). OBJECTIVE The aim of this study was to define the methodological approach for the accreditation process of CoE in RA in LA. METHODS A meeting was held in April 2015 with participation of the members of the REAL-PANLAR Steering Committee, and representatives of several LA countries, with the support of 2 experts in accreditation processes and models in Colombia. Then, in November 2015 in San Francisco and in November 2016 in Washington, the REAL-PANLAR Steering Committee met to discuss some final aspects of the project. RESULTS The following steps for accreditation were defined: application for accreditation, issuance of the concept of assessment of the entity, accreditation decision, and monitoring accreditation. CONCLUSIONS This is the second REAL-PANLAR consensus paper with the purpose to define the parameters for the accreditation process for future CoE in RA in LA.

The original version of this article, unfortunately, contained an error. The first and family name of Loreto Massardo was interchanged and is now presented correctly in this article.

The two co-authors of the mentioned above article were incorrect. The correct are authors should have been "P. A. Beltrán" instead of "P. A. B. Roa" and "J. F. Diaz-Coto" instead of "L. Diaz Soto".

The First PANLAR Rheumatology Review Course was held in Barranquilla, Colombia, in April 2015. Researchers, rheumatologists, epidemiologists, and a variety of allied professionals and patients attended the meeting. The scientific program included plenary sessions and symposia delivered by renowned experts in the field, followed by an interactive forum of discussion during 2 days.A broad spectrum of topics was discussed, reflecting the current challenges and opportunities for diagnosis and treatment of rheumatoid arthritis (RA) in Latin America. The scientific program included not only traditional disease aspects, but also social implications, research projects, and educational characteristics, patient perspectives, and novel care models, emphasizing the need for training human resources and proposing unique approaches to RA health care in Latin America, therefore helping us to increase and improve the knowledge and understanding of the characteristics of this health condition in the region, thus promoting and encouraging equity, quality, and efficiency of RA health care.

The mission of PANLAR (Pan American League of Associations for Rheumatology) is 2-fold: (1) to stimulate and promote the study and research of rheumatic diseases for the prevention, treatment, and rehabilitation of patients with rheumatic conditions in the American continent and (2) to stimulate the continuing development of the specialty of rheumatology. PANLAR is committed to encourage and facilitate patient access to care as it affects the ability of rheumatic disease patients to obtain affordable, high-quality, and specialized health care. The national health care systems within the Latin America (LA) and Caribbean area are heterogeneous in their organizational structure and complex in their operational configuration and the principles guiding the public and private sector roles in the provision of health care services. Latin American and Caribbean countries exhibit wide variations regarding their main health care systems objectives and operation. Chronic illnesses, which greatly impact health and quality of life, are actually 1 of their priorities despite requiring efforts to manage the burden of infectious diseases, providing care for the reproductive-age female population, childhood pathology, and violence-related injuries, among others.1 Patients with rheumatoid arthritis (RA) have substantial unmet medical needs. The World Health Organization recommends at least 1 rheumatologist per 100,000 people, that is, an estimated need of 6000 specialists in LA. Currently excluding the United States and Canada, the 19 LA and Caribbean Rheumatology National Societies have a workforce of around 3900 specialists to serve 588 million inhabitants. Not all rheumatologists are active, nor are they accredited according to country requirements.2 Although this number could be higher because some active practicing rheumatologists are not affiliated to their local societies, therefore, the actual number of specialists cannot be determined accurately. In addition to the shortage of rheumatologists in Latin American and Caribbean countries, the regional distribution on supply of specialists is mainly in metropolitan areas, whereas other areas have a low density of specialists, such as in rural areas and small towns, resulting in several underserved areas. These factors not only constitute barriers to patient access to specialized health care, but also contribute to a suboptimal quality of care provided, poor diagnosis, and treatment of RA in a large proportion of affected individuals.3,4 However this is not the only problem that RA patients face. Most patients in the region have limited access to medicines, rehabilitation programs, and orthopedic interventions, all of which are highly recommended for optimal disease management. Moreover, they do not have substantial education programs, which are necessary to empower them and their families in their daily management and adjustment to their illnesses, because drug therapy alone does not substantially improve quality of life.3,4 The data also reveal the importance of considering early diagnosis and adequate treatment of RA as a public health priority in Latin American and Caribbean countries, because early treatment of RA has shown to effectively reduce disability in the long run.3,4 Accurate measures known as quality indicators (QIs) are needed to assess quality of care. Quality indicators are usually more specific as compared with treatment recommendation guidelines, because they precisely describe who must do what, to whom, and exactly when.5 In 2007, the American College of Rheumatology (ACR) submitted a set of minimum QIs for RA patient care; patient adherence to these standards seems possible. Introduction of these QIs presents clinicians with an enormous opportunity to clearly understand the minimum standards expected in the profession.6 An essential goal of QIs is establishing minimum standards of care that should be delivered to patients as a means to evaluate care across patients and provider groups and stimulate quality improvement efforts that ultimately lead to better patient care and outcomes.6 The involvement of national scientific specialty organizations is an important way of delivering the message that implementing these measures is necessary for patients with RA. Eventually, it may be feasible to move beyond the specification of minimal care and reach a consensus regarding good and excellent care for our patients. There is a great potential to reduce the large and growing burden of RA across the PANLAR member societies through evidence-based interventions and harmonization of the standards of care. The REAL (Red de Excelencia en Artritis para la America Latina) project evolved as a strategic need to implement Centers of Excellence (CoEs) in RA throughout the LA and Caribbean region to help ensure affordable, high-quality, and specialized health care for these patients, improving their quality of life and managing their health care costs. Taking into account the difficulties posed by diverse health system organizations across countries and lack of resources, the REAL main goals are as follows: To promote assessment of standards of care for RA in alignment with PANLAR clinical guidelines and the Treat to Target (T2T) strategy7 To accomplish the need to measure and document disease activity, disability, comorbidities, quality of life, and adherence to treatment by RA patients To establish harmonized minimum standards of care for RA patients To inform doctors and other allied health professionals about all aspects of RA To educate patients and their family members about the facts of RA in order to help them to cope with the disease and collaborate, improving adherence to treatment and rehabilitation programs To improve patient accessibility to arthritis centers and implement continuous health care quality programs To establish and foster Latin American and Caribbean regional registries and databases To form a strategic alliance with Latin American and Caribbean governments and nongovernmental organizations in order to implement the T2T strategy and CoEs in RA throughout the LA and Caribbean region To raise awareness about the need for CoEs in RA among policy makers, private and public health payers, and insurers in the region

The use of biotechnology-derived medicines has significantly increased in recent decades. Although biosimilars undergo rigorous characterization as well as clinical studies to document their safety and effectiveness, they are highly complex molecules and small changes in the purification and production process of a biosimilar can have major implications in its safety and effectiveness profile. In Latin America, regulatory authorities have begun to establish well-described and standardized pathways that permit a biosimilar to gain commercial licensure. In order to be certain that a biosimilar reaches its potential in ordinary clinical use, an intensive post-licensing monitoring system must be established since it is the only means to ascertain the true similarity between the original biologic and its biosimilar. Pharmacovigilance allows national authorities to determine a drug's performance in the marketplace. An effective tracking and pharmacovigilance system for biological medicines has many steps and processes. To aid policy makers in Latin American in addressing the many issues surrounding the establishment of an effective pharmacovigilance system, the Americas Health Foundation convened a group of experts to discuss the topic and develop recommendations for implementation. The group discussed current challenges and gaps in pharmacovigilance in Latin America, paying close attention to the major issues associated with traceability and pharmacovigilance of biosimilars following their approval. The recommendations developed should enable countries to accurately document the safety and performance of a biosimilar as experienced by patients under real-life conditions and have a significant impact on the successful implementation of pharmacovigilance of biosimilars throughout the region.

The use of social networks as educational platforms is continually growing through a combination of formal and informal methods. This paper describes the concept of digital health and the benefits and limitations of certain digital platforms, specifically those related to social media, and explains the rise of “informed patients” and a new digital environment for patients and physicians. Additionally, useful resources providing free open-access medical education are explored, with special focus on the benefits available to medical students using Web 2.0 platforms as an accessory tool for learning.

Objective To develop guidelines for Musculoskeletal Ultrasound (MSKUS) training for rheumatologists in the Americas. Methods A total of 25 Rheumatologists from 19 countries of the American Continent participated in a consensus-based interactive process (Delphi method) using 2 consecutive electronic questionnaires. The first questionnaire included the following: the relevance of organizing courses to teach MSKUS to Rheumatologists, the determination of the most effective educational course models, the trainee levels, the educational objectives, the requirements for passing the course(s), the course venues, the number of course participants per instructor, and the percentage of time spent in hands-on sessions. The second questionnaire consisted of questions that did not achieve consensus (>65%) in the first questionnaire, topics, and pathologies to be covered at each course MSKUS level. Results General consensus was obtained for MSKUS courses to be divided into 3 educational levels: basic, intermediate, and advanced. These courses should be taught using a theoretical-didactic and hands-on model. In addition, the group established the minimum requirements for attending and passing each MSKUS course level, the ideal number of course participants per instructor (4 participants/instructor), and the specific topics and musculoskeletal pathologies to be covered. In the same manner, the group concluded that 60% to 70% of course time should be focused on hands-on sessions. Conclusion A multinational group of MSKUS sonographers using a consensus-based questionnaire (Delphi method) established the first recommendations and guidelines for MSKUS course training in the Americas. Pan-American League of Associations for Rheumatology urges that these guidelines and recommendations be adopted in the future by both national and regional institutions in the American continent involved in the training of Rheumatologists for the performance of MSKUS.

A consensus meeting of representatives of 18 Latin-American and Caribbean countries gathered in Reñaca, Chile, for 2 days to identify problems and provide recommendations for the care of patients with rheumatoid arthritis (RA) in Latin America, a region where poverty and other health priorities make the efforts to provide effective and high quality care difficult. This report includes recommendations for health professionals, patients, and health authorities in Latin America, with an emphasis on education and therapeutic issues.Fifty-one rheumatologists (list available only online on the JCR website) from 18 Latin-American and Caribbean countries with a special interest in RA participated in the consensus meeting. Participants were experts identified and appointed by the National Societies of Rheumatology affiliated with the Pan-American League of Associations for Rheumatology (PANLAR) and by the Grupo Latino Americano De Estudio de Artritis Reumatoide (GLADAR)-an independent group of Latin American rheumatologist researchers were also invited to the meeting. Eight topics were identified as priorities: patient, community and allied health professional education, health policy and decision making, programs for early detection and appropriate treatment of RA, role of classic disease modifying antirheumatic drugs (DMARDs), role of biologic therapy, and drug safety surveillance. To reach consensus, a survey with questions relevant to the topic of interest was sent to all participants before the meeting. During a 2 day meeting, the answers of the survey were reviewed and discussed by each group, with final recommendations on action items.The specific topic of the survey was answered by 86% of the participants and 68% of them answered the entire survey. It was agreed that RA and rheumatic diseases which are currently not but should be public health priorities in Latin America, because of their prevalence and impact on quality of life.Strategic areas identified as priorities for our region included: early diagnosis and access to care by multidisciplinary teams, creation of databases to identify infections with the use of biologic agents in RA which are relevant to Latin America, and overall efforts to improve the care of RA patients in accordance with international standards. Implementation of educational programs aimed to improve self-management for patients with RA was also considered crucial.

Objectives To examine current practices for the diagnosis and therapy for glucocorticoid-induced osteoporosis (GIOP) in patients under treatment with corticosteroids at outpatient clinics of rheumatologists in a Colombian Caribbean city. Methods All patients noted to be using of glucocorticoids (GC) on an index consult from February to May 2004 were included in a descriptive cross sectional study. Criteria for inclusion of patients were to have had, at least, one previous visit to the service. We evaluated the study population for osteoporosis diagnosis, procedures, and treatment. Results Of the 121 patients included, 103 (85.1%) were female and 18 (14.9%) were male; 76 patients (62.8%) were under 50 years, and 45 (37.2%) were over 50 years. Main reasons for corticosteroid use were rheumatoid arthritis in 68 patients (56.2%) and systemic lupus erythematous (SLE) in 31 patients (25.6%). Diagnostic testing for osteoporosis was reported on 50.1% of patients. Peripheral dual energy x-ray absorptiometry was the most frequently used method (52.6%). Therapeutic agents for GIOP were used in 96 patients (79.3%), with Calcium plus Vitamin D (55.2%) the principal treatments prescribed. Conclusions We found similar rates of diagnosis and treatment for GIOP to those reported in North America and Europe, although in this study treatment was mainly with calcium and vitamin D. There was a statistically significant relationship between being studied with any diagnostic method and being treated for GIOP. There may be undertreatment for GIOP in Latin America. Local interventions to improve care for patients in chronic use of steroids are needed.

Objective To determine the influence of socioeconomic factors on disease activity in a Latin American (LA) early rheumatoid arthritis (RA) multinational inception cohort at baseline. Methods Clinical evaluation, ethnicity, socioeconomic status (SES), 4-variable Disease Activity Score in 28 joints using the erythrocyte sedimentation rate (DAS28-ESR), Health Assessment Questionnaire (HAQ) disability index (DI), and erosions were recorded in 1,093 patients with early RA (

There are no formal statistics about the incidence, prevalence or demographics of patients with spondyloarthropathies (SpAs) in colombia. However, information from a few studies provides a preliminary snapshot of SpAs in the country. In this article, the authors review what has been published; document what their group is doing and outline what they still need to do in the future. The analysis suggests that although information on SpA in Colombia is limited, it is known that the diagnostic entities of SpA are different than those reported at other latitudes. Thus, it is important to improve and expand the current database of SpA, particularly undifferentiated SpA, not only in Colombia but in all of Latin America.

Objective. To validate a Spanish version of the Beck Depression Inventory (BDI) in Mexican patients with rheumatoid arthritis (RA). Methods. Thirty-five patients with RA seen in our outpatient clinic were included. A semistructured psychiatric interview was applied, and the following instruments were administered: the BDI, the Hospital Anxiety and Depression Scale (HAD), and the Health Assessment Questionnaire Disability Index. Diagnostic properties of the BDI for both full-length and smaller versions taking out somatic items were compared against a gold standard. The gold standard for comparison was the diagnosis of depression according to the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised criteria. Results. Thirty-seven percent of RA patients had a diagnosis related to depression, most of which were major depression or dysthymia. The original BDI showed a high sensitivity (92%) and a high correlation with the HAD (r = 0.83). Exclusion of somatic items in modified versions of the BDI had a similar performance. Conclusions. The original BDI is a suitable instrument to detect depression in Mexican RA patients. Nevertheless, shorter versions without some of the somatic items also show an adequate performance.

El crecimiento de la investigación científica en los últimos tiempos ha hecho necesario el desarrollo y la implementación de diversos indicadores que ayuden a medir la importancia de la investigación de cara a la propia comunidad científica. En la formación profesional del médico general y el residente de especialidades médicas se encuentra a menudo un desconocimiento o déficit en el manejo de temas sobre la producción, manejo y publicación de información científica, que conlleva a la pérdida de ideas, proyectos y tesis; que se quedan en el archivo de las bibliotecas o de los laboratorios de investigación de las universidades, sin que pasen a ser parte del desarrollo intelectual de los centros de formación o trasciendan como aportes al conocimiento científico y de la comunidad médica mundial. Uno de estos temas de vital importancia para todos aquellos interesados en la producción científica y la publicación de la misma en medios de información idóneos, revistas médicas indexadas a buenas bases de datos, que evalúan permanentemente la calidad de los trabajos, así como los requisitos para acceder a ellas sea como fuente de información veraz o como medio de publicación de gran trascendencia, es la Bibliometría. Para objetivar y hacer tangible la calidad y cantidad de la producción científica es necesario recurrir a la bibliometría como herramienta necesaria para lograr un resultado medible de la producción científica. Por tal razón se hace una revisión en la literatura médica sobre la importancia de la bibliometría, su historia, sus diferentes conceptos y aplicaciones.

Resumen Existen índices bibliométricos para valorar la producción científica en las ciencias de la salud, entre ellos, el Factor de Impacto, publicado en SCI-JCR, donde están incluidas más de 7.000 publicaciones predominantemente escritas en inglés y de donde están ausentes la mayoría de las revistas latino- americanas. Este artículo hace una revisión de la definición, cálculo, ventajas y desventajas del Factor de Impacto (FI) y evalúa otros estándares deseados como criterios de calidad que lleven a una valoración integral de las revistas médicas. Palabras claves: Factor de Impacto, revistas médicas, bibliometría, calidad editorial / SALUD UNINORTE. Barranquilla (Col.) 2006; 22 (2): 92-104 Abstract The evaluation of scientific production is realized through bibliometric indices. One of them is the Impact Factor, based on the count of citations that a scientific journal receives in a year or period. It is published in SCI-JCR, that includes more than 7.000 scientific magazines written in English, and that doesn’t include most of Latin American journals. Therefore, it’s not possible to calculate the Impact Factor for most of Latin American publications, which makes convenient the creation of an indicator of their influence on health science. This article includes the definition, calculation, advantages and disadvantages of the Impact Factor and other desired standards for the quality of the publications that may contribute to a better evaluation of medical journals. Key words: Impact factor, medical journals, bibliometry, editorial quality / SALUD UNINORTE. Barranquilla (Col.) 2006; 22 (2): 92-104