Establishing Centers of Excellence for Psoriatic Disease in Latin America: Consensus Recommendations from the REAL-PANLAR Group.

Abstract

OBJECTIVE Psoriatic Disease (PsD) is a chronic, multisystem inflammatory condition characterized by heterogeneous manifestations, including peripheral arthritis, axial involvement, enthesitis, and cutaneous and nail psoriasis. The condition has significant physical, emotional, and psychosocial impacts on patients. In Latin America, healthcare disparities exacerbate delays in diagnosis and treatment, increasing the burden of PsD and associated comorbidities. This study aimed to establish regionally adapted criteria for Centers of Excellence (CoE) to optimize PsD care. METHODS A panel of 18 experts in rheumatology and dermatology from 12 Latin American countries developed CoE criteria using the Delphi methodology. A narrative literature review informed the process, and criteria were evaluated using a Likert scale. Consensus was defined as ≥70% agreement. An in-person meeting refined unresolved items. The criteria were categorized into structure, process, and outcomes, based on Donabedian's quality evaluation model. RESULTS Two types of CoE were defined: Optimal and Model. Optimal CoEs require a multidisciplinary team including rheumatologists, dermatologists, nurses, and psychologists. Model CoEs expand this team to include gastroenterologists, ophthalmologists, physiatrists, among other specialists. Structural criteria emphasized infrastructure and electronic systems for data management. Process criteria included patient-centered education, multidisciplinary consultations, and psychosocial support. Outcomes focused on standardized clinimetric tools (e.g., PASI, DAPSA) and the "treat-to-target" strategy. Approval ratings ranged from 80% to 100%. CONCLUSION The consensus establishes a framework for CoE in PsD care in Latin America, addressing structural, process, and outcome criteria to improve clinical outcomes, patient satisfaction, and healthcare system sustainability. These standards provide a roadmap for enhancing PsD management in resource-limited settings.