Rheumatology International

, Volume 38, Issue 4, pp 549–556 | Cite as

Guidelines for management of rheumatic diseases in developing countries from basics to real-world situation: relevance, need, and processes for development

  • Durga Prasanna Misra
  • Aman Sharma
  • Vikas Agarwal
Expert Opinion


Guidelines or recommendations help to provide uniform standards in medical practice. The development of guidelines requires adherence to pre-defined norms prescribed by different international organizations such as the European League against Rheumatism (EULAR). We searched Pubmed and LILACS to identify published papers in five major rheumatic diseases (rheumatoid arthritis, systemic lupus erythematosus, spondyloarthropathies, osteoarthritis, and scleroderma) from different countries based on their economic prosperity and could find a lack of published literature from most economically weaker regions. Similarly, published guidelines in these rheumatic diseases were sparse from Asia and Africa, which are economically developed to a lesser extent than other regions of the world. Considering differing economic realities driving patient care in different regions of the world, unique challenges in certain geographic areas such as musculoskeletal manifestations of infectious diseases like leprosy and tuberculosis, as well as distinct risk of malignancies and other comorbid conditions, National Rheumatology societies should work towards developing more guidelines for rheumatic diseases from regions such as Asia and Africa, while following strictly the prescribed norms for the same. With a paucity of guidelines for such regions currently, an alternative (although less preferable) suggestion would be that major international societies, whose guidelines are widely read and followed the world over, should consider inputs from experts from diverse regions of the world while developing these guidelines.


Guidelines Recommendations Low income Lower-middle income Developing country Rheumatology 



American College of Rheumatology


Appraisal of Guidelines for Research and Evaluation


Asian Lupus Nephritis Network


Asia Pacific League against Rheumatism


Biologic disease-modifying anti-rheumatic drugs


Conventional disease-modifying anti-rheumatic drugs


Calcineurin inhibitors


European Renal Association–European Dialysis and Transplant Association


European League against Rheumatism


Grading of recommendations, assessment, development and evaluations


GRADE profiler


Gross domestic product


Gross national income


Literatura Latino Americana em Ciências da Saúde


National Institute of Clinical Excellence


Peptidyl arginine deiminase


Patient intervention comparator outcome


Preferred reporting standards for systematic reviews and meta-analysis


Protein tyrosine phosphatase 22


Standard operating procedure


World Health Organization


Author contributions

The conception and design of the study, or acquisition of data, or analysis and interpretation of data—DPM, AS, VA. Drafting the article—DPM; revising it critically for important intellectual content—AS, VA. Final approval of the version to be submitted—DPM, AS, VA. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved—DPM, AS, VA.


No funding was received for this study.

Compliance with ethical standards

Conflict of interest

Durga Prasanna Misra declares that he has no conflict of interest, including no relationship with pharmaceutical companies. Aman Sharma declares that he has no conflict of interest, including no relationship with pharmaceutical companies. Vikas Agarwal declares that he has no conflict of interest, including no relationship with pharmaceutical companies.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Supplementary material

296_2018_3996_MOESM1_ESM.docx (105 kb)
Supplementary material 1 (DOCX 105 KB)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Clinical ImmunologySanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS)LucknowIndia
  2. 2.Clinical Immunology and Rheumatology Services, Department of Internal MedicinePostgraduate Institute of Medical Education and Research (PGIMER)ChandigarhIndia

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