Rheumatoid arthritis management in the APLAR region: Perspectives from an expert panel of rheumatologists, patients and community oriented program for control of rheumatic diseases

Abstract

Rheumatoid arthritis (RA) is a major health burden in Asia Pacific affecting the quality of life of patients and consuming healthcare resources. According to recent estimates from the World Health Organization‐International League Against Rheumatism‐Community Oriented Program for Control of Rheumatic Diseases, prevalence is around 0.3%‐0.5%. Management guidelines have helped to improve treatment across this diverse region. To gain better insight into current real‐world management applications in view of these guidelines, virtual meetings were conducted in mid‐2020 to explore perspectives of rheumatologists and patients, as well as discuss the impact of coronavirus disease 2019 on RA management. Patients and rheumatologists from Hong Kong, Malaysia, Singapore, the Philippines, Thailand, India, Pakistan, and Taiwan were included, representing a diverse mix of healthcare systems, wealth, ethnicity and culture. Despite many countries having prospered in recent years, similar challenges in RA diagnosis and treatment were identified. The daily impact and patient experience of RA were also similar across countries, marked by “silent” pain and disability, and universal misunderstanding of the disease. Late diagnosis and treatment, and barriers to access to appropriate treatment, remain problematic. The experience shared by Taiwan offers a glimmer of hope, however, wherein patient advocacy groups have succeeded in being included in policy‐making decisions and securing access to advanced treatment. Real‐world solutions that pay heed to the unique local needs and diversity of Asia Pacific are required to improve RA management, which will take time. In the interim, help can be sought from the trained, non‐rheumatologist community to reduce some of the disease burden.

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“…This principle has been significantly improved over the past few years. We have successively published the Asia‐Pacific guidelines or consensus recommendation articles for osteoarthritis, rheumatoid arthritis, lupus erythematosus, spondyloarthritis, gout, and other diseases 1‐13 . During the coronavirus disease 2019 (COVID‐19) pandemic, we have also published many practical guidelines, especially for the Asia‐Pacific region 10‐13 .…”

“…We have successively published the Asia-Pacific guidelines or consensus recommendation articles for osteoarthritis, rheumatoid arthritis, lupus erythematosus, spondyloarthritis, gout, and other diseases. [1][2][3][4][5][6][7][8][9][10][11][12][13] During the coronavirus disease 2019 (COVID-19) pandemic, we have also published many practical guidelines, especially for the Asia-Pacific region. [10][11][12][13] Those important articles have improved education research and clinical care quality in rheumatic diseases in Asia-Pacific regions.…”

Efficacy and safety of tofacitinib in Chinese patients with active psoriatic arthritis: a phase 3, randomised, double-blind, placebo-controlled study

“…In Chinese patients, the prevalence of PsA is approximately 10%,4 5 although this could be underestimated in the Asia-Pacific region as patients with musculoskeletal disorders are often subject to delays in diagnosis. Other challenges that patients in this region experience include delayed or limited access to treatment with advanced therapies 5 6. Furthermore, due to limited access to information, patients may seek treatment to improve pain and disability, including traditional Chinese medicines, rather than treating signs and symptoms of inflammatory arthritis, further delaying treatment with advanced therapies 6 7…”

“…Other challenges that patients in this region experience include delayed or limited access to treatment with advanced therapies 5 6. Furthermore, due to limited access to information, patients may seek treatment to improve pain and disability, including traditional Chinese medicines, rather than treating signs and symptoms of inflammatory arthritis, further delaying treatment with advanced therapies 6 7…”

Intraindividual Changes in Rheumatoid Factor and Anti-Cyclic Citrullinated Peptide Antibody Tests in Korean Patients Visiting Local Clinics and Hospitals

“…Some reports have indicated that the level of RF decreases more strongly than does the anti-CCP level, suggesting a greater plasticity or a different cellular origin of RF with effective treatment [4]. However, the optimal clinical use of anti-CCP and RF tests is unclear [1,4,[10][11][12].…”