Current and future trends in Russian Rheumatology Care and Research

Abstract

This short article provides a description of the present state of rheumatology care and research in Russia and discusses opportunities for development and cooperation. Rheumatic diseases (RDs) in Russia represent the second most common pathology after cardiovascular disorders. Although RDs include more than 200 diseases and syndromes, the most common in Russia are osteoarthritis (OA), rheumatoid arthritis (RA), gout, and low back pain, largely similar to those seen in most Western societies. Interestingly, the prevalence of RA appears to have increased from 0.42% to 1% in the Russian population since the last large-scale epidemiologic study, which was conducted 25 years ago in the former USSR; this is an opposite trend to that seen in most Western countries 1 and is similar to other reports that have indicated that RA prevalence has risen in Europe and North America due to the underlying aging population 2 and increasing patient survival. 3 This would be interesting to study in comparative collaborative research. Approximately 10% of the Russian population is presently affected by RDs. 4 The major factors responsible for the increased prevalence of RDs in Russia include increased mutation activity associated with environmental pollution and an augmented incidence of concomitant disorders such as obesity, diabetes mellitus, hypertension, and others. Recent large epidemiologic study including 76,000 subjects from 18 regions of the Russian Federation revealed that statistical indices are significantly lower (up to 5-fold) than real prevalence of RDs among adults registered according to the attendance in clinics. 5 Besides, individual federal regions demonstrate different dynamics. For example, in Central Russia, the incidence of almost all RDs excluding osteoporosis decreased, while in the Western region, an increase in the incidence of RA and OA during one year of follow-up was observed. 6 Russia is a large territory and has a multinational population. This provides the opportunity to study different disease subtypes and phenotypes associated with genetic variability, national psychological traits, various climates, ecological conditions, and environmental factors. However, all these possibilities are limited by the insufficient funding of rheumatic research. Therefore, such type of research is a subject for future studies. Recently, Russia is developing a three-level standardized system for management of RD patients involving primary medical care, specialized treatment protocols, and rehabilitation technologies developed by the leading rheumatologic centers. Russia has great tradition in rehabilitation. Recent studies on combination of "treat to target" therapies with concomitant rehabilitation program have demonstrated that this approach is more efficient than pharmacological therapy alone primarily for early RA patients. It involves

Mediterranean Journal of Rheumatology December 2017 Highlights

“…The challenges of rheumatology care and research in modern Russia are presented by Elena Tchetina. 5 She discusses the new trends in treatment strategies of rheumatic diseases, the development of a three-tier standardized system for the management of these conditions including amongst others treatment protocols, rehabilitation and patient education programs. Of note, T2T protocols for rheumatoid arthritis in Russia are based on the initiation of high doses subcutaneous methotrexate with considerably good outcomes.…”