Rheumatoid arthritis, fibromyalgia, scleroderma, lupus, psoriatic arthritis. Joint pain, swelling, stiffness, fatigue. The symptoms “came to life”… The diagnosis of rheumatism always comes as a thunderbolt in the air. Life changes. A new reality begins for patients. Medicines, regular medical examinations, doctors of various specialties. Many times and job loss ρε Rheumatic / musculoskeletal disorders do not discriminate. They beat people of all ages mercilessly. The numbers speak for themselves: More than 100 thousand Cypriots live with some form of rheumatism. Worldwide, rheumatic diseases affect about 1.7 million people and record a dramatic increase year by year. In the last 20 years the number of patients has almost doubled, according to statistics. In the EU, more than 120 million people are ill and it is estimated that spending is close to € 240 billion, which is 2% of EU GDP and 1/4 of total health spending. Rheumatic diseases are responsible for 50% of absences from work and about 60% of permanent incapacity for work. Absences from work as a result of these illnesses translate into a total loss of € 650 billion each year. The unemployment rate is three times higher for people with rheumatic / musculoskeletal disorders compared to the general population.
New goals…
The new, revised national strategy for rheumatic diseases (2019-2023) received the green light last Thursday from the Council of Ministers. This is a very promising strategy which includes heaps of suggestions that address the long-standing problems faced by rheumatologists in Cyprus. In the context of the implementation of the objectives of the national strategy, five pillars were created through which actions will be developed with the main goal of managing rheumatic diseases through early diagnosis, treatment and rehabilitation of patients. One of the most important priorities of the new strategy is also the creation of a data file for rheumatic / musculoskeletal diseases in our country. It should be noted that the new strategy is a convergence of views of all stakeholders (doctors, patients, Ministry of Health, pharmacists, researchers, etc.).
Emphasis on information
The first pillar of the national concerns prevention, information, education of the public and health professionals. The prevention of rheumatic diseases has great potential for public health benefits, given the burden of disability and lost productivity. Due to the fact that untimely diagnosis can lead to more aggressive forms of the disease with destruction of the joints and the need for more expensive medical care but with consequent significant economic and social consequences, an important action of this strategy is to inform and educate the general population. and implementing policies for patient access to specialists. Among the suggestions are the strengthening of the effort to inform the students about the healthy lifestyle, the development of a website for the interactive electronic information of the public, patients and their families, the creation of communication forums with specialists and the establishment of direct departments access. The purpose of the information is extended to health professionals by designing and organizing short or long-term training programs and by training primary care physicians.
Diagnosis and treatment
Early diagnosis and treatment of people with rheumatic diseases is necessary to avoid permanent and temporary disability, loss of functionality, loss of ability to work as well as to treat symptoms that interfere with the normal functioning of the person and comorbidity. Hence the 2nd pillar focuses on this area. The first step in improving the diagnosis and treatment of people with rheumatic diseases is to identify the problems that exist at this stage. Patients themselves complain about the untimely recognition of the symptoms associated with rheumatism, which leads to their untimely or incorrect referral to rheumatologists from other medical specialties (eg general practitioners, orthopedists, ophthalmologists, dermatologists, etc. .).
In order to address the problem, the suggestions of those in charge include the development of actions to support rheumatology clinics of GESS. Doctors and other health professionals should also be informed and trained with the aim of helping to recognize the symptoms. The list of recommendations includes the creation of early arthritis clinics for immediate access as well as the collection of data on the time period from the onset of symptoms to the diagnosis (for example, the specialties of the doctors who evaluated the patients before referring them to a rheumatologist) for the purpose of identifying the route for early diagnosis. In terms of treatment, the new strategy makes it clear that patients should have access to innovative medicines while emphasizing the need for coordination between pharmaceutical and non-pharmaceutical interventions as well as health professionals from various medical and paramedical specialties involved. through a multidisciplinary team coordinated by the treating rheumatologist. The strategy also records a constant request from rheumatologists regarding the establishment of a rheumatology clinic, as well as the need to promote the use of electronic health and mobile health to enhance communication between doctor-patient and rheumatologists with various health professionals involved in treatment.
The third pillar of the new strategy for rheumatic diseases refers to the rehabilitation of patients. “Complete rehabilitation is achieved through systematic monitoring by a multidisciplinary team consisting of health professionals such as doctor, nurse, clinical dietitian, occupational therapist, psychologist, podiatrist and physiotherapist, gymnast,” the plan states. For the rehabilitation of the rheumatologist, it is necessary to define an evaluation protocol according to the specialty of each health professional as well as a protocol for the preparation and rehabilitation of the patient who will undergo surgery. Those in charge suggest the creation of rehabilitation centers, autonomous living programs as well as patients' access to education and reintegration programs in society. The benefits of hydrotherapy are also recorded in the presentations, with experts emphasizing the need for development in private and public swimming pools and other clinics of special hydrotherapy programs for the rehabilitation of rheumatists.
Social support
Rheumatic diseases can lead to severe disabilities and loss of functionality and ability to work resulting in huge changes in a person's life. Social support is an important intervention to ensure the good quality of life and their family for this and has been integrated in the new strategy as a separate pillar (4th pillar). The implementation of the legal frameworks that protect the chronically ill in our country has not yet taken place to such an extent that people with any form of disability enjoy equal rights and equal opportunities with other citizens of the state, one of the problems mentioned in the comments of experts . For this reason, there is a suggestion for the development of social assistance that patients receive from social workers. Another action concerns the creation of a telephone line service staffed by social workers and psychologists for guidance and support. Also, according to experts, various facilities should be instituted in the workplace, such as flexible hours for people with rheumatism, while the inclusion of a special course in medical schools is recommended to raise students' awareness of the way in which they report the disease to patient and his environment.
In numbers
Rheumatic diseases are responsible for:
- 50% of long-term functional disability
- 30% of all absences from work
- 20% of medical visits
- 25% of prescription drug use
Research and requests of rheumatologists
The rheumatic disease strategy also places great emphasis on research. The fifth pillar refers specifically to data recording and research as they are considered as “the basic condition for the development of a rational strategy for the treatment of rheumatic and musculoskeletal disorders”.
In Cyprus there are no official statistics or epidemiological data on the frequency of rheumatic diseases. Therefore, there can be no accurate estimates of the prevalence or impact of rheumatic diseases in the Cypriot population. Particularly important is the conduct of population-level epidemiological studies to assess the prevalence of rheumatic and musculoskeletal diseases and the creation of a relevant registry of rheumatic patients in the context of developing an organized and comprehensive epidemiological surveillance system.
What do rheumatologists ask for?
- Improvement of medical care and rehabilitation by creating a rheumatology clinic, provincial rheumatology centers and multifunctional rehabilitation centers.
- Information for the prevention of rheumatic diseases – first symptoms, healthy lifestyle, early diagnosis.
- Strengthening information about rheumatism – who suffers from it, what exactly it is like to live with these conditions, what can be done to improve the quality of life after diagnosis.
- Informing health workers.
