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Joint stiffness upon waking? The first alarm bell of a rheumatic disease- breaking latest news

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from Vera Martinella

Over 5 million Italians suffer from one of the 150 rheumatic diseases: diagnosis often late, when they are more difficult to treat and the risk of disability is greater

There are over five million Italians who suffer from a rheumatic disease: there are over 150, very different from each other in frequency and severity. What they have in common is that almost all of them are often diagnosed late, when they are more difficult to treat and expose you to a greater risk of disability. This also happens because most patients tend to neglect the first signs of these pathologies for a long time or do not know how to recognize their symptoms. “They are characterized by inflammation of the joints with involvement of all the structures that make up the locomotor system and often also affect the internal organs – says Gian Domenico Sebastiani, president-elect of the Italian Society of Rheumatology (Sir), whose annual meeting is in progress in Rimini -. Subtle and silent, rheumatic diseases gradually consume the cartilage and nearby tissues without initially giving obvious signs of themselves. And if not treated they can progressively lead to disability ».

Beware of these symptoms

The first alarm bell that we must learn not to ignore is the appearance of joint pain (typically in the hands, feet or spine) especially in the morning: “Solidly, after a night’s rest, patients have joint stiffness that lasts even an hour or two – explains the national president of the Society Roberto Gerli -, when even the first difficulties in the movement appear. Maybe with added pain and swelling. However, many people neglect symptoms for a long time, while recognizing the signs and reaching a diagnosis as soon as possible would be essential to limit the damage they can cause ». According to the estimates presented by the specialists during the conference, over 800 thousand people in Italy are at risk of disability, for example, due to the most severe forms of rheumatoid arthritis, seronegative arthritis, spondylitis or psoriatic arthritis. “If it takes an average of five years to identify a rheumatic disease such as fibromyalgia (in three quarters of cases it is initially mistaken for simple back pain), for ankylosing spondylitis from the beginning of the symptoms to the diagnosis it usually takes seven – continues Marco Gabini, general secretary of SIR -. To intervene on the diagnostic delay, considering that the pharmacist is one of the first people to turn to when they feel pain, we wanted to carry out an educational operation with Federfarma Servizi pharmacists. We have already carried out the first training courses for pharmacists, to help them interpret the symptoms, and throughout 2022 they will be able to share numerous brochures on the main rheumatological diseases with the population ».

40% of sufferers have to leave their jobs

Rheumatic diseases can arise at any age, but more often they affect adults at the height of their social and professional life. On which disability has a social weight, as well as a personal one, of great impact. In many cases there are effective therapies which, especially if administered at the beginning of the disease, can allow patients to lead a normal life. “40% of the more than five million Italian rheumatic patients are forced to leave work – underlines Maurizio Montecucco, president of the Italian Foundation for Arthritis Research (Fira) -. Nothing like early diagnosis would, thanks to timely therapeutic intervention, produce a human, social and economic benefit for rheumatology patients, families and the entire community. It is a need that emerged as a Public Health objective also in the National Prevention Plan 2020-2025 which, thanks to the Covid experience, contains a series of governance indications at central, regional and local level. Fundamental to measuring the success of early diagnosis operations in the area must be the monitoring and evaluation of processes and outcomes. Unfortunately, the National Chronicity Plan is still awaiting update, however it has not been fully implemented at the regional level ».

Targeted therapies

An early diagnosis is also the prerequisite for personalized therapy: «The final destination is precision medicine which aims to identify the best therapeutic approach for the management of the individual patient suffering from a specific disease – adds Sebastiani -. Also for rheumatic diseases, as already happens in tumors, we are trying to identify biomarkers that make it possible to stratify patients and predict the response to a therapy so as to be able to choose, for each patient, the most suitable treatment based on the disease. which suffers. For example, the drugs available for rheumatoid arthritis (in the last 20 years innovative treatments have arrived that have produced a significant improvement in prognosis, with the possibility of putting the disease into remission) have shown different efficacy in patients: the challenge is now to understand who can benefit from one treatment rather than another and take advantage of the possibility of using organic ones ».

Understanding back pain

Still too many people also underestimate the symptoms of back pain which, if due to a rheumatological disease, can be very painful and impacting on patients’ lives. 39% of those interviewed for a survey carried out by the family doctor claim to have it even after rest. For seven out of ten the pain developed gradually over time, 54% suffer from morning stiffness for over 30 minutes. For 85%, back pain improves with the use of drugs. The campaign was born to help sufferers get a diagnosis “Re) know my back pain” promoted by the National Association of Rheumatic Patients (ANMAR) together with the Italian Federation of General Practitioners (Fimmg), created thanks to the unconditional support of Novartis Italia. «The role of the general practitioner in recognizing the first signs of serious pathologies is fundamental – concludes Silvia Tonolo, president of ANMAR -. With this initiative we have asked for an effort to help us design a virtuous path that can improve the timeliness of diagnosis of the main rheumatic diseases, such as ankylosing spondylitis, anticipating the patient’s care by the specialist, but also the management of the pathology in the its chronicity “. And according to Domenico Crisarà, national deputy secretary of the Fimmg, “the possibility of using innovative tools for detecting contextual symptoms at the time of comparison and examination of patients allows family doctors to effectively intercept clinical cases that otherwise could be identified in any case. an evolved phase of the disease “.

November 26, 2021 (change November 27, 2021 | 17:39)

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