Joint stiffness when you wake up? The first alarm bell for a rheumatic disease – Corriere.it

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of Vera Martinella

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

There are more than five million Italians who suffer from rheumatic disease: there are more than 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, even though they are more difficult to treat and put you at 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 internal organs – explains 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 surrounding tissues without manifesting themselves at first. And if they are not treated, they can gradually lead to disability ”.

Watch out for these symptoms

The first alarm bells that must be learned not to ignore is the appearance of joint pain (typically in the hands, feet or spine) especially in the morning: two – explains the national president of the Society Roberto Gerli – when even the first difficulties of the movement appear. Perhaps with additional pain and swelling. However, many people neglect the symptoms for a long time, while recognizing the signs and making a diagnosis as early as possible would be essential to limit the damage they can cause ”. According to estimates presented by specialists at the conference, more than 800,000 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 . “While it takes an average of five years to identify a rheumatic disease such as fibromyalgia (in three quarters of cases it is first confused with simple low back pain), for ankylosing spondylitis from the onset of symptoms until diagnosis it usually takes seven years – continues Marco Gabini, secretary general of the SIR -. To intervene in the diagnostic delay, considering that the pharmacist is one of the first people to turn to when he feels pain, we wanted to carry out an educational operation with the pharmacists of Federfarma Servizi. 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 with the population numerous brochures on the main rheumatological diseases ”.

40% of patients have to quit their jobs

Rheumatic diseases can occur at any age, but they most often affect adults at the height of their social and professional life. On which the handicap has a social weight, as well as a personal one, of great impact. In many cases, there are effective therapies available which, especially if given early in the disease, can allow patients to lead normal lives. “40% of the more than five million Italian rheumatic patients are forced to quit their work – underlines Maurizio Montecucco, president of the Italian Foundation for Arthritis Research (Fira) -. Nothing like early diagnosis, through timely therapeutic intervention, would yield human, social and economic benefit for rheumatology patients, families and the community as a whole. It is a need that appeared as a Public Health objective also in the National Prevention Plan 2020-2025 which, thanks to the Covid experience, contains a series of indications of governance at the central, regional and local level. Monitoring and evaluation of processes and results should be fundamental to measuring the success of early diagnostic operations in the area. Unfortunately, the National Chronicity Plan is still awaiting updating, however it has not been fully implemented at the regional level ”.

Targeted therapies

An early diagnosis is also a 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 with a specific disease – adds Sebastiani -. Also for rheumatic diseases, as it already happens in tumors, we try to identify biomarkers that allow patients to be stratified and the response to therapy to be predicted in order to be able to choose, for each patient, the most suitable treatment. depending on the disease. who suffers. For example, the drugs available for rheumatoid arthritis (over the past 20 years have arrived innovative treatments 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 now is to understand who can benefit from one treatment rather than another and take advantage of the possibility of using organic treatments ”.

Understanding back pain

Still too many people also underestimate the symptoms of back pain which, if caused by rheumatologic disease, can be very painful and impact the lives of patients. 39% of people questioned as part of a survey conducted by the family doctor say they suffer from it even after rest. For seven in ten people the pain has developed gradually over time, 54% suffer from morning stiffness for more than 30 minutes. For 85%, back pain improves with the use of medication. The campaign was born to help patients get diagnosed “Re) know my back pain” promoted by the National Association of Rheumatic Patients (ANMAR) in collaboration with the Italian Federation of General Practitioners (Fimmg), created with 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 asked for an effort to help us design a virtuous pathway that can improve the speed of diagnosis of the main rheumatic diseases, such as ankylosing spondylitis, by anticipating the patient’s care by the specialist, but also the management from pathology to its chronicity ”. And according to Domenico Crisarà, deputy national secretary of Fimmg, “the possibility of using innovative tools to detect contextual symptoms when comparing and examining patients allows family physicians to effectively intercept clinical cases. which could otherwise be identified in all cases. an advanced phase of the disease ”.

November 26, 2021 (modified November 27, 2021 | 5:39 PM)


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