Jornal Médico – Rheumatic diseases: horizon until 2030

Jornal Médico – Rheumatic diseases: horizon until 2030

A new National Health Plan (PNS) will be published soon, which will be valid until 2030. Luís Cunha Miranda, from the Portuguese Institute of Rheumatology, criticizes the document he revised, highlighting the chapter on rheumatic and musculoskeletal diseases. Read the opinion article.

There is a new National Health Plan (PNS) to be published soon and it has a time horizon until 2030, it has about 300 pages on which a guide to improve the health of Portuguese would supposedly be formed and with clear strategies and goals undertaken. takes into account the impact of various diseases, both in terms of mortality and in terms of disability and quality of life.

It is said that life expectancy in Portugal is growing, but that in the last years of our lives, our elderly are among those who are living with a poorer quality of life this year. Rheumatic and musculoskeletal diseases (RMD) are among the diseases that affect the elderly, those that contribute the most to this loss of quality of life. And it is with this assumption that I reviewed PNS 2021-2030, trying to imagine which strategies go beyond reducing mortality from some diseases, which is a strategic vision of aging and disability.

The first almost 200 pages talk about indicators and the framework that ranges from demographics through access to drinking water to COVID-19 (whose relevance for 2030 is eluding me).

However, through the document, we learned that the SBS and its experts manage to invent concepts and terms that no one else in the world of medicine uses. MRD, which could only be rheumatic diseases, began to be called in Portugal and only in our country musculoskeletal diseases, something deeply wrong both in terms of concept and in terms of nomenclature. However, as an interesting fact, we also learned that these diseases are the ones with the most disabilities and that from 2009 to 2019 they increased very significantly.

So DRM in a sense Disability-adjusted life years (DALYs)are the ones that grew the most from 2009 to 2019. Together with low back pain, which is also MRD, they increased by 16.5% and correspond to 7% of the total DALY of all diseases, making them the diseases with the greatest disability.

If we connect to this the analysis of the burden of disease and disability Age with Disability (YLDs) in which DRM increased by 33.1% from 2009 to 2019, with different DRMs standing out in this disease burden indicator (1st place back pain, 6. osteoarthritis, 7. other musculoskeletal diseases disorders, 10. neck pain) which in total corresponds to 21.7% of all YLDs, with post-depressive illness having 6.8% of the impact, or 1/3 of the impact of DRM.

We can say that MRDs are the diseases with the greatest increase in impact on DALY and YLD and that they are nevertheless neglected and reduced in the national health strategy whose priorities are not in line with the impacts on either sustainability or strategic vision. for the health plan until 2030.

There are situations in the PNS that, when they are caricatured, do not fail to reflect that lobbies there are. So, in the document, we have an exaggerated emphasis on two important pathologies, but whose real impact is diminishing.

In the document there is this section “Tuberculosis and HIV infection should also be taken into account because, although their incidence is declining, they still have a relevant size.” The SBS provides a political rather than a technical assumption, as tuberculosis is obviously much lower and less affected than other infectious diseases, and even rheumatic diseases such as rheumatoid arthritis, psoriatic arthritis, osteoporosis fracture or lupus. (SLE). Therefore, its size stems from the existence of specific national programs in the SBS and media visibility, rather than actual economic, social, mortality or other impact. In fact, there has been an increase in sexually transmitted diseases other than HIV and they are not considered in specific strategies to reduce them. Neither is eradication of hepatitis C considered, although feasible.

Obviously, reducing mortality in several neoplasms, as well as cardiovascular events or diabetes should, and is, a national priority in PNS, but leaving aside multiple rheumatic and non-rheumatic pathologies, we repeat formulas from the last century and push the population, which will soon be one of the five oldest in the world, for painful aging and no quality of life.

SBS experts derive from the coordination of sectoral programs and these programs have an effective value of visibility, but also access to project funding, without quotas for programs, which implies that several million made available for several years dominated several diseases ..

When assessing PNS, it is maladapted to the potential negative disability and burden of MRD and other diseases (eg neurological or mental health) not related to mortality have a huge impact on all strategies ranging from human resources to health, accessibility, direct and indirect costs and future sustainability of the system. Of the diseases with low associated mortality, two diseases with a minimum burden of disease compared to Alzheimer’s, depression, SLE or rheumatoid arthritis, for example, were “selected”.

Finally, it remains to ask the SBS, given that there are 12 priority programs and 11 non-priority ones, why the adoption of the National Program against Rheumatic Diseases (PNCDR) began in 2004 as a priority, ended in 2014 and never continued. this decision finds that DRM is the disease with the greatest increase in impact, as established by the PNS in its text.

We live in a time of great technical and scientific demand, but also issues such as the sustainability of the SNS and social security, and the PNS must be a document with intellectual characteristics, with a vision of the future and, above all, technically and scientifically based. This one, which will be published with little or no amendment, is just a health policy document with pressure groups at work, smart instead expertsto value certain specialties and health workers to the detriment of others who may be more qualified.

In the case of rheumatology, it is PNS of musculoskeletal diseases and therefore without joints, which indicates their deep ankylosis and aversion to movement and stopped change, waiting for poor quality but incompetent aging.

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