Rheumatoid arthritis in Latin America: challenges and solutions to improve its diagnosis and treatment training for medical professionals.

Rheumatoid arthritis (RA) is a disease with multiple clinical manifestations and chronic complications that requires a multidisciplinary team to treat and monitor patients. This understanding between the different medical and health professionals is essential in obtaining patient well-being. This is the reason behind the assessment of the difficulties and limitations seen in Latin America in the field of rheumatology. The aim is to suggest possible mechanisms and solutions to strengthen the knowledge and understanding of the way the disease behaves and how it can be handled by doctors and medical professionals.

Chikungunya infection in the general population and in patients with rheumatoid arthritis on biological therapy.

Chikungunya infection is a febrile illness, which currently is afflicting the Caribbean islands including the Dominican Republic. We would like to report our experience with Chikungunya-related musculoskeletal manifestations in our arthritis clinics in the Dominican Republic. A total of 514 patients presented for the first time to our arthritis clinic exhibiting musculoskeletal manifestations, 473/514 (92%) exhibiting symmetric polyarthralgias, 344/514 (67%) arthritis, and 385 (75%) skin rash. The great majority 457.46 (89%) exhibited very good clinical response to nonsteroidal anti-inflammatory drugs (NSAIDs), 370 (72%) require low-dose steroids, and only 5 patients (0.97%) required methotrexate therapy. In addition, of a total of 328 patients with rheumatoid arthritis on biological treatment, 53 exhibited Chikungunya-related musculoskeletal manifestations; 51/53 (96.2%) exhibited symmetric polyarthralgias, 25/53 (47.1%) arthritis, and 13/53 (24.5%) tendinopathy. Of most patients, 51/53 responded to NSAIDs, of which, 23 patients only responded partially, and in total 25 (47.1%) required low-dose steroids. Disease-modifying antirheumatic drug (DMARD) therapy including biologics remained unchanged in this population.