Emilce Edith Schneeberger

Background: In the context of treatment recommendations for rheumatoid arthritis (RA), it is important to establish definitions related to treatment adjusted in specific situations and in the presence of comorbidities. Objectives: To develop recommendations based on the best evidence regarding to the treatment of patients with RA in special situations, healthy habits, and the presence of comorbidities. Methods: A systematic literature review was conducted in PubMed, LILACS, and the Cochrane Library until April 30, 2023. Two independent methodologists selected studies. Draft statements were developed and voted on, with ≥70% agreement required for inclusion. Results: Fifty-four statements were formulated. Key recommendations include: against treatment in asymptomatic high-risk individuals without clinical arthritis (preclinical RA); the use of methotrexate in seropositive patients with imaging-detected subclinical arthritis; definitions for early RA, window of opportunity, difficult-to-treat RA, and sustained remission; guidance on DMARD during pregnancy and breastfeeding; preference for non-TNF biologics in obese patients; caution with TNFi in stage III to IV congestive heart failure; antiviral prophylaxis in chronic hepatitis B; and structured recommendations on oral hygiene and smoking cessation. Conclusions: These statements complement general RA treatment recommendations and support better patient management, based on scientific evidence and adapted to the characteristics, resources, and opportunities of our country.

Introduction: In recent years, PANLAR has addressed gender equity. Objectives: To analyze the characteristics of speakers participating in PANLAR congresses and to compare the distribution of speakers by gender. Methods: Speakers who participated in the annual PANLAR congresses from 2021 to 2024 were identified by reviewing the corresponding scientific programs. The following data were recorded: age, sex, nationality, country of residence, speaker category, type of participation (moderator, speaker at general conferences, or speaker at industry-sponsored symposia), years in the specialty, and workplace. Statistical analyses included descriptive statistics, the χ ² or Fisher exact test, and the Student t test. Results: A total of 430 speakers participated in the four annual PANLAR congresses held from 2021 to 2024. The median age was 48 years (IQR: 40 to 60), and 231 speakers (53.7%) were men. Of these, 337 were adult rheumatologists (79.3%). The main countries of origin of the speakers were Colombia (21.6%), Brazil (20.9%), and Argentina (13.7%). Among the speakers, 114 participated as moderators, 337 as speakers at general conferences, and 67 as speakers at pharmaceutical industry-sponsored symposia. Among rheumatologists who treated adult patients, the proportion of men was higher than that of women in both moderator roles and general conferences, although these differences were not statistically significant (men 58.4% vs. women 41.2%, and men 53.6% vs. women 46.4%, respectively; p =NS). Men participated significantly more often than women in pharmaceutical industry-sponsored symposia (men 71.4% vs. women 28.6%; p =0.005). The mean numbers of moderator roles, general lectures, and industry-sponsored symposia were also significantly higher among men than among women. Conclusion: Men accounted for a higher proportion of moderators and speakers at PANLAR annual meetings during the study period, with a more pronounced gender disparity in pharmaceutical industry-sponsored symposia.

Background: Rheumatoid arthritis (RA) is a severe, systemic chronic rheumatic disease, and it is important for each country and/or region to develop management recommendations adapted to its needs and resources. Objectives: To update the Argentine treatment recommendations for the management of patients with RA. Methods: The working group comprised a principal investigator, 8 methodologists and 23 expert rheumatologists. Seventy-one PICO questions were developed. A systematic literature review (SLR) was conducted using the Medline (PubMed), LILACS, and Cochrane Library databases. Grey literature was also searched. The evidence was appraised using the GRADE methodology. Voting was anonymous and conducted virtually, and recommendations required at least 70% agreement to achieve consensus. Results: A total of 21 recommendations were developed, addressing Mediterranean diet, subcutaneous versus oral methotrexate, and therapeutic strategies across different clinical scenarios, including: csDMARD naive, inadequate response (IR) to csDMARD, IR to b/tsDMARD (cycling versus swapping), monotherapy, tapering in patients with sustained remission, and management of patients with concomitant interstitial lung disease or rheumatoid vasculitis. In most cases, the levels of evidence and degrees of agreement were moderate. Conclusions: These recommendations are intended to be a practical tool to assist rheumatologists in making the most appropriate treatment decisions for their patients.

Introduction Treatment persistence is a surrogate marker for long-term treatment success. Objectives To assess the persistence of biological agents used for treatment of patients with rheumatoid arthritis (RA) over 5 years period and determine variables associated with persistence or discontinuation. Methods A systematic literature review (SLR) and meta-analysis were performed. We performed a bibliographic search through Pubmed, Cochrane and Lilacs databases, and ACR, EULAR, PANLAR abstracts until January 2020. Two independent reviewers evaluated the identified publications, by title and abstract and full text, according to PICO methodology. Eligibility criteria: RA patients ≥ 18 years, treated with biological agents, which measured persistence/ discontinuation for a period of time ≥ 5 years and who were in English or Spanish language. Results Among 809 articles, 56 articles were selected, leading to a total of 72,677 (range: 79–10,396) patients, with a mean age of 53.8 years ± 12.1, 78.2% female and an average RA disease duration of 9.7 years ± 8.4. Data from 29 publications were pooled for an exploratory meta-analysis of the persistence of b-DMARDs in the 2nd line of treatment at 5 years. Tocilizumab (TCZ) had the highest persistence 66% (CI 95% 60–72), followed by golimumab (GLM) 62% (47–75). Regarding the 3rd therapeutic line, the greater persistence corresponded to abatacept (ABA) 45% (41–50) and etanercept (ETN) 41% (30–53). Lower survival rates predictors were: greater use of steroids, higher baseline disease activity, and female gender. Conclusions In this study, TCZ and GLM showed higher 5-years persistence vs other b-DMARDs in 2nd line treatment. Key Points • The persistence of biologic disease modifying anti-rheumatic drugs (b-DMARDs) is a surrogate marker of long-term treatment success as it represents an indirect measure of clinical effectiveness, the absence of significant adverse events (AE) and satisfaction with treatment. • This systematic literature review (SLR) and meta-analysis included observational studies and long-term extension of randomized controlled studies, allowing us to evaluate drug retention over a 5-year period, from different perspectives and the b-DMARDs that have been on the market for less time. • The highest 5-year persistence of b-DMARDs in patients with inadequate response to conventional synthetic (cs-) DMARDs was for tocilizumab and golimumab. While in b-DMARDs experienced patients, abatacept and etanercept presented the higher retention.

The best screening way to detect interstitial lung disease (ILD) in patients with rheumatoid arthritis (RA) is still debated. To evaluate the performance o