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In view of the variability in the management of axSpA in Latin America, there is a need to generate a common guideline through evidence-based recommendations that makes it possible to homogenize management practices in the Americas, adapted to the needs and the context of the Pan American League of Associations for Rheumatology (PANLAR) community and the socioeconomic challenges within the different countries in the region

While it is known that B-vitamin supplementation effectively treats hyperhomocysteinemia, there is a need for well-designed, large trials to evaluate the effect of B-vitamin supplementation on long-term outcomes, such as age-related cognitive decline and the incidence of Alzheimers disease

Biologic response modifiers

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Conversely, when they had lower PUCAI scores, indicating more moderate illness, they had higher fecal levels of these SCFAs