Latin America and the Caribbean (LAC) is a rapidly growing region with almost 600 million inhabitants composed of Mexico, Central and South America, and the islands of the Caribbean. The population of LAC is one of the most diverse in the world. There is an increased prevalence of chronic diseases in LAC which has been attributed to diverse causes, including ancestry, socioeconomic status, the ageing of the population, and lifestyle factors such as smoking, physical inactivity, and excessive alcohol intake (Arthritis 2013; 2013:256493).
The prevalence of some autoimmune rheumatic diseases, including rheumatoid arthritis (RA), is higher than expected among some Amerindian groups thus highlighting ancestry as a factor influencing the risk of acquiring autoimmune diseases. RA prevalence in LAC ranges from 0.4 to 1.6% (J Clin Rheumatol 2012;18:167-9).
Compared to Caucasians, RA in LAC has an earlier age at onset and affects more women than men (5.2:1) with some clinical characteristics that differ from RA presentation in men (Gend Med 2012; 9:490-510). Cardiovascular disease in LAC RA patients is 35% (Arthritis 2012; 2012:371909).
PANLAR and the “Grupo Latino Americano de Estudio de Artritis Reumatoide” (GLADAR) have issued some guidelines for the pharmacological treatment of RA that promote an early aggressive therapy. Early disease clinics are established in some LAC countries. The GLADAR experience has shown that most early RA patients (i.e., <1 year of disease duration) receive methotrexate. Combination therapy is used in approximately 1 of every 4 patients as initial therapy. Biologics are rarely used at this early stage, but low-dose prednisone is commonly used (J Clin Rheumatol 2012;18:327-35). In patients with established RA, biologics are used in 15-40% of cases. The advent of biosimilars gains more importance in LAC countries because they promote cost containment favoring the sustainability of modern health systems in a panorama of aging population, demographic transition towards chronic diseases like RA, costly health technologies, and limited resources (Biosimilars 2013;3:1-17). As stated by Burgos-Vargas et al. “challenges for LAC countries in the treatment of RA include making the disease a public health priority, knowing its socioeconomic impact in terms of its high cost and burden on the health-care system, and increasing access to prompt diagnosis, treatment by rheumatologists, and availability of effective low cost medications (Reumatol Clin 2013;9:106-12).”
Disclosure of Interest None declared