Rheumatology Training in Latin America: A Collaborative Study by the Pan American League of Associations for Rheumatology

Rheumatoid arthritis in Latin America: pharmacotherapy and clinical challenges

INTRODUCTION

Rheumatoid arthritis (RA) presents significant healthcare challenges in Latin America (LA) due to its high prevalence and unique healthcare dynamics. Despite global advancements, LA faces specific hurdles in managing RA effectively.

AREAS COVERED

This manuscript reviews the epidemiology, pharmacotherapies, and clinical challenges of RA in LA. RA prevalence varies, with higher rates in indigenous populations. Treatment guidelines recommend conventional disease-modifying antirheumatic drugs (csDMARDs) as first-line therapy, but access is inconsistent. Biologics, and targeted synthetic DMARDs, are available in most LA countries, though biosimilars are less accessible, with significant variations in drug prices. Barriers to treatment include supply interruptions, diagnosis delays, and high non-adherence rates linked to socioeconomic factors. The severe shortage of rheumatologists, especially in rural areas, impacts patient outcomes. Cardiovascular events and, other comorbidities and endemic infections, further complicate RA management in LA.

EXPERT OPINION

LA has seen improvements in RA management with better use of csDMARDs, treat-to-target strategies, and advanced treatments. However, challenges remain, including the shortage of rheumatologists, limited continuous medical education, endemic infections, and fragmented healthcare systems. Addressing these issues requires expanding training programs, leveraging telemedicine, and ensuring consistent drug supply. Enhancing clinical research and local data information and improving access to affordable treatments are crucial for better patient outcomes. Comprehensive, region-specific strategies are needed to bridge the gap between LA and more developed regions in RA care.

Speciality training in rheumatology: Promotion, repetition and dropout rates in the city of Buenos Aires

OBJECTIVES

To evaluate the trajectory of students enrolled in the specialty training in rheumatology.

METHODS

Retrospective analysis (2009-2016). Promotion, repetition, and dropout rates were determined. Analysis was performed to define variables associated with academic success.

RESULTS

Out of 119 students, the actual promotion rate was 66.4%, 11.8% failed an exam (at least) and completed the course after the stipulated time, and the dropout rate was 7.6%. Among residents, the promotion rate was 82.5% vs. 48.2% among the rest (p < 0.001), the lagging students' repetition rate was 3.2% vs. 21.4% among the rest (p 0.005), and the dropout rate was 3.2% vs. 12.5% among the rest (p = 0.06). A higher average score in medical school increased the chances of success in the postgraduate programme (OR 3.41 CI 95% 2.0-6.4; p < 0.001).

CONCLUSIONS

The residency was associated with higher rates of academic success in postgraduate studies. The average score in medical school can help identify students at risk of failure.

Burden of Other Musculoskeletal Disorders in Latin America and the Caribbean: Findings of Global Burden of Disease Study 2019

OBJECTIVE

To describe the results from the Global Burden Disease (GBD) study 2019 on the burden of other musculoskeletal (MSK) disorders in Latin America and the Caribbean (LAC).

METHODS

In this cross-sectional study, we analyzed data from all LAC region in the GBD study from 1990 to 2019. Other MSK (other than rheumatoid arthritis, osteoarthritis, gout, low back pain, and neck pain) burden was measured as prevalence, mortality, years lived with disability (YLD), and disability-adjusted life (DALY), by year, sex, and country. We show the counts, rates, and 95% uncertainty intervals (95% UI). Joinpoint regression analysis was used to estimate the average annual percentage change (AAPC) from 1990 to 2019. A correlational analysis between the burden parameters and sociodemographic index (SDI) was performed.

RESULTS

In 2019, there were 52.0 million (95% UI, 44.8-60.1 million) individuals with other MSK disorders in LAC. The age-standardized mortality rate in 2019 was 1.2 (95% UI, 0.8-1.6) per 100,000 inhabitants. The AAPC was estimated as 0.1% (95% confidence interval [CI], 0.1-0.2) and 0.2% (95% CI, 0.1-0.3) for prevalence and mortality rates, respectively. The age-standardized DALY rate was 685.4 (95% UI, 483.6-483.6) per 100,000 inhabitants, representing an AAPC of 0.2% (95% CI, 0.1-0.3). The burden was larger in women and the elderly. The SDI was positively correlated with the prevalence of YLD in 2019.

CONCLUSIONS

LAC region has experienced a significant burden of other MSK disorders over the last three decades. To challenge this growing burden, population-based strategies designed to reduce the burden of other MSK and strengthen health systems to contribute effective and cost-efficient care are necessary.