The Latin American Practical Guidelines for Treatment of Lupus were published recently in the Annals of the Rheumatic Diseases. The guidelines were the result of a two-year research effort involving more than 100 investigators, clinicians and patient advocates. The research was conducted by members of GLADEL (Latin American Group for the Study of Lupus) and PANLAR (Pan American League of Associations of Rheumatology), with the help and support of volunteers from the Argentina Lupus Association.
Previous long-term epidemiology studies have identified disparities in the way lupus impacts people of different races and ethnicities. The authors in their paper noted that these earlier studies, along with data from patient registries, “have demonstrated that Latin American and North American Mestizo patients (mixed Amerindian and European ancestry), African descendants and Native Americans develop lupus earlier although diagnostic delays may occur. They also experience more severe disease, have higher disease activity levels, accrue more organ damage and have higher mortality rates, succumbing mainly to disease activity and/or infections.”
Treatment guidelines have been developed previously for patients with lupus. However, certain regional issues called for specific guidelines for patients living in Latin America. The authors stated that these issues include: the regional variances for the physical manifestations of lupus, treatment response and disease outcomes among people of Latin American origin, the costs and availability of medications used to manage lupus, and patient adherence to treatment recommendations.
Guidelines’ Overarching Principles
Nine organ/system sections are presented within the main findings, along with the five overarching principles.
- Treatment should be individualized, specialists and generalists should work together and the active involvement of patients and their family members on the overall therapeutic plan should be emphasized.
- The therapeutic goal should be to reach and maintain remission or low-disease activity as soon as the diagnosis is made and for as long as possible.
- Treatment should include photo-protection, osteoporosis, cardiovascular, metabolic syndrome and infection prevention, psychological support and pregnancy counselling.
- All patients with lupus should receive AMs#, except those who refuse them or who have absolute contraindications to take them.
- GCs#, if clinically needed, regardless of patient’s disease manifestations, should be prescribed at the lowest possible dose and for the shortest period of time.
# AM, antimalarials; GC, glucocorticoid; GLADEL, Grupo Latino Americano de Estudio del Lupus; PANLAR, Pan-American League of Associations of Rheumatology
Guidelines Benefits Extend Beyond Latin America
The authors of this critical paper also call attention to the globalization of treatment options for people with lupus. Therefore they note that the guidelines may have practical applications for clinicians around the world. From the paper …
(P)roblems faced by Latin American countries are shared by several developing nations. Therefore, it is expected that these guidelines will also be very useful for them. Furthermore, due to ever increasing globalization and the increase of migratory movements of people from countries with more susceptible SLE groups in terms of frequency and disease severity both in terms of race/ethnicity (Mestizos, Asians, Africans) and low SES to countries with better life opportunities, we consider that these guidelines may be used by physicians anywhere in the world, even in developed countries, where such individuals may migrate to and seek care for their lupus.
The World Lupus Federation wishes to congratulate the members of GLADEL and PANLAR for their valuable contribution to improving treatment of lupus around the world. We also extend our appreciation to the leaders and volunteers of the Argentina Lupus Association for their assistance with developing and promoting the guidelines.