Introduction to the PANLAR Guidelines: Giant Cell Arteritis
Dr. Sebastián Unizony tells how the process of construction and consolidation of this document by the team of experts was.
EF: Hi everyone, welcome to a new Global Rheumatology video blog. We are with Dr. Sebastián Unizony, who will present the Pan American guidelines for giant cell arteritis. Doctor, welcome.
SU : Thank you very much, Estefania. Thanks for the invitation.
EF: How important is it that we have Pan-American guides?
SU : Well, I think the importance is a lot. For the first time to have guides developed by Latin American experts or authors, Latin American people and providers or doctors. When the guides were developed we considered the socioeconomic and cultural context from the Latin American or Spanish American region, that is the importance, for the first time having homemade guides, so to speak. I work in the United States, but I worked for many years in Argentina, so I consider myself one more when it comes to making the guides.
EF: How did this entire construction process take place specifically for these that you are going to present?
SU : Well, the guidelines were developed, all three, the one I am presenting is the one for giant cell arteritis, but there are also guidelines for Takayasu 's disease and anca-associated vasculitis. The work team was divided into two, there was a group of 10 experts in vasculitis from Mexico, Peru, Colombia, Brazil and Argentina, and then there was a group of seven methodologists, so for the guidelines what we did was first get together among the experts and develop a series of pertinent or important questions when treating patients with these diseases, we gave these questions to the methodologists, the methodologists did a systematic search of the bibliography, from thousands of articles they ended up studying dozens, because the articles that were included in this type of guide are very specific, they are mostly randomized placebo-controlled studies and also of lower quality.
The methodologists do this search, extract the information, rate the quality of the evidence as high, moderate, low, or very low, and then they give us this digested in a summary back to the experts, the experts then vote on the questions, an example of these questions that are asked in a format called PICO (population, intervention, comparison, outcome – population, intervention, buyer and outcome), for example, drug A is better than drug B for the treatment of patients with X with respect to the relapse rate, then after the experts vote, we have to be 70% in agreement and after the vote the recommendations are written.
EF: What did all this work mean for you as researchers as members of PANLAR?
SU : Well, it involved a lot of work, a lot of hours spent in discussions, it was also a lot of fun, but it was quite hard. One of the things that I take with me from work is to interact with my peers from other countries and learn the socioeconomic realities, the barriers that exist when treating these diseases that are mostly rare diseases, they are orphan diseases, so in practice they present inconveniences when using medications that on the other hand are very frequently used in other diseases such as rheumatoid arthritis, but when it comes to wanting to use them for diseases like these there are barriers, there is difficulty in access, so for me it was very important to learn from my colleagues the realities of the different countries that are not very different from each other.
EF: Who are these guidelines aimed at, only rheumatologists or do we broaden the spectrum?
SU: Yes, they are aimed at rheumatologists, as well as to patients, but as we know not only in Latin America but in the world, the number of rheumatologists per number of inhabitants is declining over time and in many regions there are fewer rheumatologists than one would like, one would like one for every 100,000 inhabitants or 50,000 inhabitants, and in many places those numbers are not given. Therefore, we think that the guidelines will be useful for clinicians, neurologists, ophthalmologists, any other doctor or specialist who is treating patients with GSI or other vasculitides.
And the other thing is that the guidelines are designed for Latin America, but they are done very well, very rigorously, studying all the available evidence, so they can be used in other parts of the world without problems.
EF: Specifically in this case as a region with these guides, how do we position ourselves globally in terms of research and progress?
SU : Good in the sense that until today the most important guides come from Europe and the United States, from EULAR and ACR, and these are also important Latin American guides. That puts us a little on a par with other important societies, whatever to mention is that most of the studies that were used to make these guides are from works that have been developed outside of Latin America and this is not new either, it is one of the limitations that the region still has. Hopefully, these guidelines will help to promote or create interest in these diseases, so that later there will be more research and ultimately that future research on Latin American patients done in Latin America will perhaps provide better answers or more specific answers for the region. They place us very well, but they also show us that there is a lot to do.
EF: In line with this, will these guidelines allow or change the topic of diagnoses and treatments for our population a little?
SU: Yes, especially the treatment, they are treatment guidelines. In the future we will update them and will certainly include diagnostic aspects, but for now they are treatment guidelines and yes, they will definitely change. Hopefully they will change, I don't think they will change, hopefully they will organize and structure the treatment of these diseases that are rare and that many rheumatologists are not very familiar with and fewer doctors who do not do rheumatology every day, so hopefully this will help to facilitate management and also luck, as I said before many of the medications we use are medications that are relatively easier to obtain for diseases such as rheumatoid arthritis and more difficult to use for Takayasu, for example. Hopefully, these guides will organize the treatment and will help doctors when requesting, processing these medications for their patients, life will be easier for these doctors and, of course, for the patients who are going to take them.
EF: We are talking about PANLAR 2022, so the closing question is what is your recommendation in this congress?
SU : The recommendation is very simple, enjoy and interact. We come from two and a half years of pandemic, of doing everything virtual. Well, now is the opportunity to get back in the game, network, chat with friends and connect. That is my recommendation.
EF: Doctor, thank you very much and success with all this research and the guides that we are presenting, which have meant important progress for us as a region.