Establishing centers of excellence for axial spondyloarthritis in Latin America: consensus recommendations from the REAL-PANLAR Group

Abstract

Objective Axial spondyloarthritis (axSpA) is a chronic inflammatory condition primarily affecting the sacroiliac joints and spine, often complicated by extramusculoskeletal manifestations such as uveitis, psoriasis, and inflammatory bowel disease. Delayed diagnosis due to nonspecific symptoms, coupled with regional disparities in healthcare infrastructure in Latin America, exacerbates disease burden, emphasizing the need for specialized care. This project aimed to develop a regional consensus for establishing Centers of Excellence (COEs) in axSpA management.

Methods A Delphi methodology was employed, involving 16 rheumatology experts from 12 Latin American countries. A structured process included a systematic literature review, questionnaire validation, and consensus building during a virtual and in-person meeting. Criteria were categorized into initial premises, structure, processes, and outcomes, guided by the Donabedian quality evaluation framework.

Results The consensus established 3 COE classifications—standard, optimal, and model—defined by resource availability and care standards. Human resources criteria highlighted multidisciplinary teams, including rheumatologists, physiatrists, and dermatologists, with agreement rates ranging from 70.6% to 100%. Structural requirements, such as electronic health systems for traceability and continuous training, achieved consensus levels between 81.3% and 100%. Process-related criteria emphasized comprehensive care models, treat-to-target strategy implementation, and validated clinimetric tools (eg, Ankylosing Spondylitis Disease Activity Score, Bath Ankylosing Spondylitis Disease Activity Index), with approval ratings of 70.6% to 100%.

Conclusion This consensus establishes a scalable framework for COEs in axSpA in Latin America, balancing high-quality care standards with regional healthcare limitations.