Rheumatology: 10 million patients, a White Paper on access to treatment and innovation

They affect more than 10 million Italians and 120 million Europeans, from children to the elderly; they often develop during the prime of working and reproductive life. Although they are among the leading causes of chronic pain and disability, they remain little understood. These are rheumatic diseases, for which the 30th World Day is observed on 12 October. To mark the occasion, the Italian Society of Rheumatology has presented a White Paper to the relevant institutions, setting out priority guidelines for action to ensure that patients have truly equitable and timely access to the most appropriate treatments.

Rheumatology has undergone a veritable revolution over the last twenty years, thanks to which we now have a range of options at our disposal. These include the possibility of early diagnosis; the availability of innovative medicines and biosimilars, the use of which broadens access to the most advanced treatments whilst keeping costs down; personalised and multidisciplinary care models; and telemedicine and telemonitoring, which promote continuity of care and reduce unnecessary hospital admissions. Given that rheumatic diseases represent one of the country’s major health and socio-economic challenges, focusing on rheumatology and promoting its areas of excellence is a high-value investment for our National Health Service. The more successfully we can diagnose and treat these conditions at an early stage, the more we will achieve not only better clinical outcomes but also fewer cases of disability, hospital admissions and surgical procedures, and an increasing number of people who will continue to work and look after their families.

Despite the progress made, however, significant regional and organisational disparities persist, which may affect the timeliness of diagnosis and treatment. We have powerful knowledge and tools at our disposal, but not all citizens are able to benefit from them equally. A person’s place of residence can still influence the diagnostic and treatment options available to them if they have a rheumatic condition. In some regions, patients may have to wait more than six months for an initial consultation, with the risk of delaying diagnosis and allowing the disease to progress.

The figures reveal a network that remains uneven. There are 42 Complex Rheumatology Units (0.71 per million inhabitants), with very marked differences between the regions.

Access to innovation also presents challenges: around 23 per cent of rheumatologists working in outpatient settings are unable to prescribe biologics directly, forcing patients in some cases to seek treatment at another authorised centre. There are also significant differences in university training: in medical degree programmes, rheumatology accounts for between one and four credits depending on the university, and some institutions do not have a full professor in the subject.