Health Spondyloarthritis, much more than joint pain

Spondyloarthritis, much more than joint pain

Spondyloarthritis, much more than joint pain

The spondyloarthritis They are a mixed family of chronic inflammatory diseases different, but interrelated, since they share a series of symptoms and precipitating mechanisms of the disease and response to treatment. These diseases include mainly axial spondyloarthritis and the psoriasic arthritis, among other. It is estimated that in Spain there are at least half a million patients with spondyloarthritis, the diagnosis being usual in theyoung adult between 30 and 50 years. These are diseases that are characterized by the high impact they have on the quality of life of patients in all areas of their lives and beyond the physical symptoms. To know this impact in detail and how, both strategically and clinically, its approach is proposed, jolly groupin collaboration with AbbVieheld a meeting on June 12 with the participation of managers, clinicians and patients.

Carmen Lamadeputy director of Strategies, Plans and Processes of the Health Department of the Junta de Andalucia, made an approach to the Andalusian Plan for Rheumatic and Musculoskeletal Diseasess, launched since 2018, and its vocation to improve referrals between Primary Care and hospitals. “Historically, Rheumatology was a specialty that was only present in first and second level hospitals and from Primary School it was not referred directly without going through Traumatology. That has changed since it slows down and makes the situation more complex, ”he explained. Being high-impact diseases, the Plan aims to “reduce diagnostic delay and improve patient care from the first moment a disease is suspected,” Lama stressed.



The manager of the Valme University Hospital, in Seville, Rocio del Castillo, highlighted that, in general, day-to-day health care is focused on Primary Care, where most of the medical and nursing acts are carried out. “As a manager of a hospital area, I am lucky to have both heterogeneous Primary Care and geographical dispersion, as well as a hospital that has an excellent Rheumatology service.” Therefore, “it is important establish fluid communication between the different levels of care, to treat the patient in the most suitable place at the right time”. “This implies involve Primary Care, nursing consultation and Rheumatology consultation”, he stressed. Likewise, he stressed that “our duty is to provide them with the best possible care, considering your concernswhich are not always what we might think”.

The doctor Alejandro Escuderospecialist in Rheumatology from the Rheumatology Clinical Management Unit of the Reina Sofia University Hospital, explained that spondyloarthritis have an approximate prevalence of 0.8% in the national population. “They present particular symptoms, low back pain being one of the most common and often underestimated. This type of pain can limit night rest and affect work productivity, especially in young people.

Pain can limit night rest and seriously affect work and social life

In addition to pain and limitation, these diseases can have different forms of presentation, not always associated with pain. “Some manifestations include inflammatory symptoms in peripheral joints such as knees, ankles, and wrists, with intermittent episodes that may require recurrent medical attention. The referral to rheumatologist for proper diagnosis and treatment It is essential,” he stressed. Likewise, he emphasized the impact that spondyloarthritis has on the quality of life, especially in a young part of the population.

Marcos Garridorepresentative of the Spanish Coordinator of Spondyloarthritis Associations (CEADE), gave an account of the path to diagnosis of spondyloarthritis, “which can be long and difficult and, in many cases, it can take up to 8 years.” In his opinion, the diagnosis can be complicated, since there is often a lack of communication between the patient and the specialists. “Sometimes it is referred to the traumatologist, which can delay the proper diagnosis,” he says.

Regarding the scope of the pathology, “although at first the symptoms may seem mild, over time they develop complications that limit mobility and can cause disability. In addition, he emphasized that these diseases usually manifest in early adulthood, “at an important vital moment when people enter the labor market or start a family.” “Is as if a bomb went off in their livessince it is a chronic disease with which they will have to live for the rest of their lives,” he said.

On the other hand, Garrido alluded to the need to improve equity and access to therapeutic innovation. “The genetic component and the systemic nature of these diseases require advanced therapies not always availableyeah,” he said. He also defended the role of patient associations to complement treatments with options that give very good results, such as self-help processes, psychological care, rehabilitation workshops, the work of physiotherapy or the promotion of adequate physical exercise or activities such as yoga, pilates or aquagym. “Keeping the patient active is essential to combat rigidity”, he stressed. Lastly, he highlighted the legal difficulty in achieving work incapacity.

Carmen Lama wanted to bring up the work of the Process Manager, which helps decide whether the patient should be referred to one specialist or another or be treated from Primary Care. In his opinion, “a culture change is needed to favor humanization, and it has to be consistent with care, attending to the multiple needs of the person”, and favor intersectoral assistance where there is a good connection with, for example, Employment or Social Services.

In this sense, Dr. Escudero wanted to value the work of nursing consultations. “In our Unit we have a Nursing person who tries to answer many questions raised by patients related to their day-to-day life, since, despite the good doctor-patient relationship, many times we, depending on the weather, must be more focused on treatment issues.

What is the extent of these diseases?

spondyloarthritis are immune mediated diseases and complex in which the immune system mistakenly attacks the healthy cells of the joints, causing inflammation and joint deterioration that can damage the bones. The Axial spondyloarthritis presents two stages of the disease: one of them most initial and precocious, called Non-Radiographic Axial Spondyloarthritisand a more advanced one called Ankylosing spondylitis (AS)). People with Non-Radiographic Axial Spondyloarthritis may present signs and symptoms similar to AD, including chronic low back pain and functional loss, although, as the name suggests, they still do not show radiographic changes that indicate damage to the bone structure. Therefore, the diagnosis is more complex. AD is an inflammatory, chronic and autoimmune disease that affects more than 5 million people in the world and, in Spain, 300,000 people. They are diseases with notable impact on the quality of life of people who suffer from it. As reflected by the Barometer encuEspAsurvey to know the impact of spondyloarthritis, a third of the patients manifest having to miss work and consider that their working life has suffered due to illness. In addition, regarding the impossibility of carrying out daily activities, for more than half of the patients, certain actions such as climbing stairs (51%) or getting out of bed (53%) are limited. 45% of patients have to stop doing day-to-day activities due to the pain caused by the disease, 70.1% are worried about pain and 66.3% due to loss of mobility and autonomy. For all these reasons, the participants in the colloquium defended the need to make reality visible of these people, ensure a multidisciplinary approach, favor a early diagnostic that allows establishing the appropriate treatment as soon as possible and allocate resources to cushion the labor impact and social of the disease.

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