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Elmamoun M, Eraso M, Anderson M, Maharaj A, Coates L, Chandran V, Abogamal A, Adebajo AO, Ajibade A, Ayanlowo O, Azevedo V, Bautista-Molano W, Carneiro S, Goldenstein-Schainberg C, Hernandez-Velasco F, Ima-Edomwonyi U, Lima A, Medina-Rosas J, Mody GM, Narang T, Ortega-Loayza AG, Ranza R, Sharma A, Toloza S, Vega-Espinoza L, Vega-Hinojosa O. International league of associations for rheumatology recommendations for the management of psoriatic arthritis in resource-poor settings. Clin Rheumatol 2020; 39:1839-1850. [PMID: 31950441 PMCID: PMC7237392 DOI: 10.1007/s10067-020-04934-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/26/2019] [Accepted: 01/06/2020] [Indexed: 01/17/2023]
Abstract
Background Psoriatic arthritis (PsA) is a challenging heterogeneous disease. The European League Against Rheumatism (EULAR) and the Group for Research and Assessment of Psoriasis and PsA (GRAPPA) last published their respective recommendations for the management of PsA in 2015. However, these guidelines are primarily based on studies conducted in resource replete countries and may not be applicable in countries in the Americas (except Canada and USA) and Africa. We sought to adapt the existing recommendations for these regions under the auspices of the International League of Associations for Rheumatology (ILAR). Process The ADAPTE Collaboration (2009) process for guideline adaptation was followed to adapt the EULAR and GRAPPA PsA treatment recommendations for the Americas and Africa. The process was conducted in three recommended phases: set-up phase; adaptation phase (defining health questions, assessing source recommendations, drafting report), and finalization phase (external review, aftercare planning, and final production). Result ILAR recommendations have been derived principally by adapting the GRAPPA recommendations, additionally, EULAR recommendations where appropriate and supplemented by expert opinion and literature from these regions. A paucity of data relevant to resource-poor settings was found in PsA management literature. Conclusion The ILAR Treatment Recommendations for PsA intends to serve as reference for the management of PsA in the Americas and Africa. This paper illustrates the experience of an international working group in adapting existing recommendations to a resource-poor setting. It highlights the need to conduct research on the management of PsA in these regions as data are currently lacking.Key Points • The paper presents adapted recommendations for the management of psoriatic arthritis in resource-poor settings. • The ADAPTE process was used to adapt existing GRAPPA and EULAR recommendations by collaboration with practicing clinicians from the Americas and Africa. • The evidence from resource-poor settings to answer clinically relevant questions was scant or non-existent; hence, a research agenda is proposed. |
Electronic supplementary material The online version of this article (10.1007/s10067-020-04934-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M Elmamoun
- Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Canada
| | - M Eraso
- Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - M Anderson
- Library and Information Services, University Health Network, Toronto, Canada
| | - A Maharaj
- Prince Mshiyeni Memorial Hospital, Durban, South Africa
| | - L Coates
- University of Oxford, Oxford, UK
| | - Vinod Chandran
- Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Canada. .,Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Canada. .,Institute of Medical Science, University of Toronto, Toronto, Canada. .,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada. .,Department of Medicine, Memorial University, St. John's, Canada.
| | | | - A Abogamal
- Al-Azhar Faculty of Medicine Cairo, Nasr City, Egypt
| | - A O Adebajo
- University of Sheffield UK, Western Bank, Sheffield, S10 2TN, UK
| | - A Ajibade
- Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun state, Nigeria
| | - O Ayanlowo
- College of Medicine, University of Lagos/Lagos University Teaching Hospital Nigeria, Ishaga Rd, Idi-Araba, Lagos, Nigeria
| | - V Azevedo
- Federal University of Parana, Curitiba, PR, Brazil
| | - W Bautista-Molano
- University Hospital Fundación Santa Fe de Bogotá and School of Medicine Universidad Militar Nueva Granada, Bogota, Colombia
| | - S Carneiro
- State University of Rio de Janeiro and Federal University of Rio de Janeiro, Av. Pedro Calmon, 550 - Cidade Universitária da Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, 21941-901, Brazil
| | - C Goldenstein-Schainberg
- Disciplina de Reumatologia, LIM-17, Hospital das Clinicas HCFMUSP, Faculty of Medicine - University of Sao Paulo, Sao Paulo, SP, Brazil
| | | | - U Ima-Edomwonyi
- College of Medicine, University of Lagos/Lagos University Teaching Hospital Nigeria, Ishaga Rd, Idi-Araba, Lagos, Nigeria
| | - A Lima
- Regional University of Blumenau (FURB), Blumenau, SC, Brazil
| | - J Medina-Rosas
- Posthumous, University of Valle, University of La Sabana, Imbanaco Medical Center, Cali, Colombia
| | - G M Mody
- University of KwaZulu-Natal, Durban, South Africa
| | - T Narang
- Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India
| | - A G Ortega-Loayza
- Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd, Portland, USA
| | - R Ranza
- Rheumatology Unit, Federal University of Uberlandia, Uberlândia, MG, Brazil
| | - A Sharma
- Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India
| | - S Toloza
- Ministry of Health, Catamarca, Catamarca, Argentina
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Kluyts HL, le Manach Y, Munlemvo DM, Madzimbamuto F, Basenero A, Coulibaly Y, Rakotoarison S, Gobin V, Samateh AL, Chaibou MS, Omigbodun AO, Amanor-Boadu SD, Tumukunde J, Madiba TE, Pearse RM, Biccard BM, Abbas N, Abdelatif AI, Abdoulaye T, Abd-rouf A, Abduljalil A, Abdulrahman A, Abdurazig S, Abokris A, Abozaid W, Abugassa S, Abuhdema F, Abujanah S, Abusamra R, Abushnaf A, Abusnina S, Abuzalout T, Ackermann H, Adamu Y, Addanfour A, Adeleke D, Adigun T, Adisa A, Adjignon SV, Adu-Aryee N, Afolabi B, Agaba A, Agaba P, Aghadi K, Agilla H, Ahmed B, Ahmed EZ, Ahmed AJ, Ahmed M, Ahossi R, Aji S, Akanyun S, Akhideno I, Akhter M, Akinyemi O, Akkari M, Akodjenou J, AL Samateh A, al Shams E, Alagbe-Briggs O, Alakkari E, Alalem R, Alashhab M, Alatise O, Alatresh A, Alayeb Alayeb M, Albakosh B, Albert F, Alberts A, Aldarrat A, Alfari A, Alfetore A, Algbali M, Algddar A, Algedar H, Alghafoud I, Alghazali A, Alhajj M, Alhendery Alhendery A, Alhoty F, Ali A, Ali Y, Ali A, Alioune BS, Alkassem M, 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Roos J, Rorke NF, Roura H, Rousseau F, Rousseau N, Royas L, Roytowski D, Rungan D, Rwehumbiza S, Ryabchiy B, Ryndine V, Saaiman C, Sabwa H, Sadat S, Saed S, Salaheddin E, Salaou H, Saleh M, Salisu-Kabara H, Doles Sama H, Samateh AL, Sam-Awortwi W, Samuel N, Sanduku D, Sani CM, Sanyang L, Sarah H, Sarkin-Pawa A, Sathiram R, Saurombe T, Schutte H, Sebei M, Sedekounou M, Segooa M, Semenya E, Semo B, Sendagire C, Senoga S, Senusi F, Serdyn T, Seshibe M, Shah G, Shamamba R, Shambare C, Shangase T, Shanin S, Shefren I, Sheshe A, Shittu O, Shkirban A, Sholadoye T, Shubba A, Sigcu N, Sihope S, Sikazwe D, Sikombe B, Simaga Abdoul K, Simo W, Singata K, Singh A, Singh S, Singh U, Sinoamadi V, Sipuka N, Sithole N, Sitima S, Skinner DL, Skinner G, Smith O, Smits C, Sofia M, Sogoba G, Sohoub A, Sookun S, Sosinska O, Souhe R, Souley G, Souleymane T, Spicer J, Spijkerman S, Steinhaus H, Steyn A, Steyn G, Steyn H, Stoltenkamp HL, Stroyer S. The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications. Br J Anaesth 2018; 121:1357-1363. [PMID: 30442264 DOI: 10.1016/j.bja.2018.08.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/19/2018] [Accepted: 08/06/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications. METHODS ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery. RESULTS The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784. CONCLUSIONS This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance. CLINICAL TRIAL REGISTRATION NCT03044899.
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Affiliation(s)
- H-L Kluyts
- Department of Anaesthesiology, Sefako Makgatho Health Sciences University, Pretoria, Gauteng, South Africa
| | - Y le Manach
- Department of Anesthesia, Michael DeGroote School of Medicine, Faculty of Health Sciences, McMaster University and Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Perioperative Medicine and Surgical Research Unit, Hamilton, ON, Canada; Department of Clinical Epidemiology and Biostatistics, Michael DeGroote School of Medicine, Faculty of Health Sciences, McMaster University and Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Perioperative Medicine and Surgical Research Unit, Hamilton, ON, Canada
| | - D M Munlemvo
- University Hospital of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - F Madzimbamuto
- Department of Anaesthesia and Critical Care Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - A Basenero
- Ministry of Health and Social Services Namibia, Windhoek, Namibia
| | - Y Coulibaly
- Department, Faculté de médicine de Bamako, Bamako, Mali
| | | | - V Gobin
- Ministry of Health and Quality of Life, Jawaharlal Nehru Hospital, Rose Belle, Grand Port, Mauritius
| | - A L Samateh
- Department of Surgery, Edward Francis Small Teaching Hospital, Banjul, Gambia
| | - M S Chaibou
- Department of Anesthesiology, Intensive Care and Emergency, National Hospital of Niamey, Niamey, Niger
| | - A O Omigbodun
- Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - S D Amanor-Boadu
- Department of Anaesthesia, University College Hospital, Ibadan, Oyo State, Nigeria
| | - J Tumukunde
- Makerere University, Makerere, Kampala, Uganda
| | - T E Madiba
- Department of Surgery, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - R M Pearse
- Intensive Care Medicine, Queen Mary University of London, London, UK
| | - B M Biccard
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Observatory, Western Cape, South Africa.
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