REAL-PANLAR Project for the Implementation and Accreditation of Centers of Excellence in Rheumatoid Arthritis Throughout Latin America: A Consensus Position Paper From REAL-PANLAR Group on Improvement of Rheumatoid Arthritis Care in Latin America Establishing Centers of Excellence.

OBJECTIVE: A consensus meeting of representatives of 16 Latin American and Caribbean countries and the REAL-PANLAR group met in the city of Bogota to provide recommendations for improving quality of care of patients with rheumatoid arthritis (RA) in Latin America, defining a minimum standards of care and the concept of center of excellence in RA. METHODS: Twenty-two rheumatologists from 16 Latin American countries with a special interest in quality of care in RA participated in the consensus meeting. Two RA Colombian patients and 2 health care excellence advisors were also invited to the meeting. A RAND-modified Delphi procedure of 5 steps was applied to define categories of centers of excellence. During a 1-day meeting, working groups were created in order to discuss and validate the minimum quality-of-care standards for the 3 proposed types of centers of excellence in RA. Positive votes from at least 60% of the attending leaders were required for the approval of each standard. RESULTS: Twenty-two opinion leaders from the PANLAR countries and the REAL-PANLAR group participated in the discussion and definition of the standards. One hundred percent of the participants agreed with setting up centers of excellence in RA throughout Latin America. Three types of centers of excellence and its criteria were defined, according to indicators of structure, processes, and outcomes: standard, optimal, and model. The standard level should have basic structure and process indicators, the intermediate or optimal level should accomplish more structure and process indicators, and model level should also fulfill outcome indicators and patient experience. CONCLUSIONS: This is the first Latin American effort to standardize and harmonize the treatment provided to RA patients and to establish centers of excellence that would offer to RA patients acceptable clinical results and high levels of safety.

Fibromialgia y depresión: evolución de la fibromialgia en pacientes deprimidos y no deprimidos / Fibromyalgia and depression: evolution of fibromyalgia in depressed and non depressed patients

Se realizó un estudio prospectivo de la evolución de un grupo de 26 pacientes portadores de fibromialgia. Dicho grupo fue subdividido en dos subgrupos: pacientes que asociaban depresión y pacientes que no. Se siguio la evolución de cada grupo que fue tratado siguiendo los estándares terapéuticos actuales, con el objetivo de evaluar la implicancia que tenía la asociación de fibromialgia con depresión. Del análisis estadístico de los subgrupos, se llegó a la conclusión de que la evolución a corto plazo de la fibromialgia está en directa relación con la presencia de sintomatología depresiva, mejorando significativamente el dolor y el estado anímico cuando se asoció un tratamiento antidepresivo. Se considera la importancia de llegar a un correcto diagnóstico de ambas entidades (fibromialgia-depresión) para lograr un mejor abordaje terapéutico de las mismas. Se tuvo en cuenta, también, que este trabajo aporta datos originales en cuanto al manejo terapéutico de estos pacientes que deben ser valorados en un contexto interdisciplinario