Aug 29, 2021
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Rheumatologists sound the alarm

Rheumatologists sound the alarm

The pandemic has deprived patients of affordable drugs.

During the pandemic, many people with chronic diseases found themselves in a situation of severely reduced access to medical care. Including patients with rheumatological pathologies, many of whom require long-term or even lifelong therapy with expensive drugs.

On the one hand, the drugs used in the treatment of this group of diseases turned out to be effective in the treatment of covid, which led to their shortage on the market. On the other hand, the decrease in the costs of the health care system has reduced their availability even more.

Rheumatological diseases are a whole group of severe pathologies, which are based on autoimmune processes and in the development of which inflammatory markers known to many today called interleukins are often involved. The most common among these diseases are rheumatoid arthritis, lupus erythematosus, ankylosing spondylitis. But, of course, there are many more.

Academician of the Russian Academy of Sciences, President of the All-Russian public organization “Association of Rheumatologists of Russia”, the chief freelance specialist-rheumatologist of the country Evgeny Nasonov notes that all rheumatic diseases are chronic and without high-quality therapy, they progress and lead to a worsening of the patient’s condition: “In our country, these diseases suffer more than 2 million people, and every year we identify about 60 thousand new patients. However, modern innovative therapy gives them not just a chance for life, but also a chance for a quality life, because it prevents their progression. “

The Russian Association of Rheumatologists, already in the early stages of the pandemic, prepared recommendations for the management of patients with rheumatic diseases. “Unfortunately, the risk of getting sick in our patients is higher, and it is very important that during a pandemic we preserve all the achievements of rheumatological care so that patients do not interrupt treatment,” continues Academician Nasonov.

However, alas, the availability of targeted drugs for patients has decreased over the past year, which is not surprising. Many monoclonal antibodies, previously used in rheumatology, have been “transferred” to the fight against covid. In addition, for several months there were interruptions with hydroxychloroquine, which they tried to use in the treatment of coronavirus, as a result, its effectiveness was never confirmed, but rheumatological patients had serious problems with its availability. In addition, health care costs have been reduced, and the treatment of this group of diseases is quite expensive. For example, a year of therapy for a patient with psoriatic arthritis costs 440 thousand rubles, for rheumatoid arthritis – 470 thousand, and ankylosing spondylitis – 395 thousand rubles.

At the same time, opportunities for timely diagnostics have become less accessible. Academician of the Russian Academy of Sciences, Professor, Director of the Research Institute of Rheumatology, North-Western State Medical University named after I.I. Mechnikova Vadim Mazurov complains that today patients receive a correct diagnosis late: sometimes it takes several years, and if treatment is not prescribed early, the disease begins to progress and quickly leads to disability. “Only timely started adequate therapy, regular monitoring by the doctor can improve the patient’s condition and lead him to long-term remission. The “window of opportunity” for starting basic therapy is six months, and I see three success factors for achieving good results: correct diagnosis, that is, the patient must get to a rheumatologist on time, early initiation of therapy and adherence to treatment. It is equally important to ensure continuity so that the patient can continue treatment at the place of residence, ”says Academician Mazurov.

In recent years, rheumatological diseases increasingly begin at a young age. However, if the patient does not start treatment immediately and after a few years becomes disabled, the country already loses 1.5 million rubles. “Thus, it is more profitable for the state to invest in early diagnosis and innovative therapy, because with optimal patient management, these investments will be paid back in 2-3 years,” says Ruslan Dreval, an expert in the field of healthcare and drug supply.

The sad thing is that patients are entitled to free medicines only when they apply for disabled status. The problem is that as soon as there is an improvement, this status is removed from the young man. As a result, he does not receive treatment, and the disease begins to progress. This situation has been going on for many years, but things are still there. It is possible to get out of this vicious circle only by ensuring that all necessary therapy is available in polyclinics for all rheumatological patients, regardless of whether they are disabled or not.

In addition, experts believe that in order to improve the situation of this group of patients, it is necessary to expand the possibilities of telemedicine, introduce hospital-substituting technologies and allocate within the framework of the compulsory medical insurance the provision of drug care within the hospital at home.

Arina Petrova.


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