“The current shortage of rheumatologists makes it difficult to treat patients referred to us from primary schools.”

Pablo Malo Segura (Bilbao)
Dr. Sagrario BustabadPresident of the Spanish Society of Rheumatology (BE), participated on February 16 and 17 in Bilbao IX Symposium on Systemic Autoimmune Diseases. In this regard, he was present iHealth talk about the main developments and the potential of CAR-T in these pathologies, as well as the situation in rheumatology in Spain and future challenges. Rheumatic diseases are the second reason for visiting primary health care. after respiratory infections. “For patients referred to us from elementary with the current shortage of rheumatologists“, he pointed out. In this sense, he emphasized the importance of using the potential of virtual consultations and telemedicine to prioritize the most urgent cases.

How many people suffer from systemic autoimmune rheumatic diseases in Spain? What is the most common patient profile?
There is no exact number of people suffering from systemic autoimmune diseases in Spain. Studies show that every fourth Spaniard suffers from rheumatic diseases of all types. The incidence of systemic autoimmune diseases averages 0.8. There are other rheumatic diseases that are much more common and are caused by aging and degeneration.

“Systemic autoimmune diseases occur in young people, have a profound impact on quality of life, and can have a fatal prognosis.”

On the other hand, systemic autoimmune diseases occur in much younger people, greatly impact quality of life, and can sometimes have a fatal prognosis. Additionally, when it occurs in women, especially between the ages of 20 and 45, it affects the fertile period. It is necessary to make an early diagnosis in order to be able to apply treatment as quickly as possible. There is a lot of research being done on these diseases, and we now have treatments that are much more effective than those we used five or ten years ago.

What are the main topics and developments discussed at the IX Symposium on Systemic Autoimmune Diseases?
The topics discussed ranged from the etiopathogenetic mechanism of the causes, which are being studied and differences are visible, to the application of treatment methods that lead to changes in new criteria. This allows them to be used as early as possible, which is important for preventing consequences and changing the quality of life.

Why is it important to hold these types of symposiums and how do you think they contribute to increasing the knowledge of professionals?
What is not reported or disclosed does not seem to exist, especially when it comes to less common diseases. These types of events have two goals: to improve specialist knowledge of new developments so that they can be applied to patients, and to disseminate information about rheumatic diseases. The downside is that these diseases are often seen as something more related to aging. It is important that patients attend these symposiums so that they learn about these rheumatic diseases and know that they need to be prevented, treated and diagnosed early.

“The Spanish Society of Rheumatology is a leader in teaching and research projects”

What other training initiatives does the Spanish Society of Rheumatology have?
The Spanish Society of Rheumatology is a leader in teaching and research projects. We are one of the few scientific societies with a research arm that runs partnership projects and registries for diseases such as lupus or monitoring biological treatments.

We are concerned about the shortage of rheumatologists and we have an initiative that is a plan to help by collaborating, visiting consultation services and pushing for more placements and better primary care protocols. Politicians have many tasks, and we must help make the situation with rheumatology visible.

What potential does CAR-T therapy have in systemic autoimmune diseases?
We are beginning to use CAR-T therapy in these diseases. This is a completely new treatment method that is effective for other diseases and has potential for rheumatic diseases. It is now used as an alternative when other treatments fail. There is very little experience, but we hope to see more results in these patients in the near future.

“CAR-T therapy is potentially useful in rheumatic diseases and is used as an alternative when other treatments are ineffective.”

Are there enough rheumatologists in Spain? Is it necessary to increase the number of MIR places in the specialty?
Rheumatology is a relatively young specialty when compared with traumatology or rehabilitation, but more and more patients with rheumatological problems are being referred to us. It is very important that patients are referred to us as early as possible. Currently, due to the lack of rheumatologists, the treatment of patients referred to us from primary schools is difficult. For this reason, some virtual consultations are conducted in primary care settings to prioritize the most urgent cases.

It is clear that more positions for MIR rheumatologists need to be created, the population is aging and in the next ten years the number of rheumatologists will decrease by almost 40%. Additionally, in populations where there is geographic dispersion, it is difficult for rheumatologists to travel and these locations are also unattractive.

“We must create more MIR-rheumatology positions, in the next ten years the number of rheumatologists will decrease by almost 40%”

Rheumatic diseases are the second leading cause of visit to primary health care after respiratory infections. From there, patients are referred to hospitals or specialized medical care centers. Demand is high and we need more rheumatologists. It is important that rheumatology classes in medical schools be taught by rheumatologists, as this increases student interest in the specialty. For this purpose, the university should create positions for rheumatologists.

How important is it for hospitals to have faculty accreditation departments?
Regarding teacher accreditation units, the National Commission on Specialties requests a number of criteria for their accreditation. These criteria have not changed for at least ten years, but medicine has evolved during this period. Help varies and you cannot request the same items. For example, now we hardly accept patients, since we treat them on a consultative basis or as a day hospital. Therefore, we may not reach the figure requested by the ministry.

We are working to change these criteria and become eligible to have sites with teacher accreditation units. These hospitals must also have a certain number of rheumatologists and meet other criteria. There are not enough rheumatologists, and there are places where there are openings but they are not filled. Moreover, there are areas where contracts are very weak and professionals are reluctant to work.

“Rheumatic diseases are the second reason for visiting primary care after respiratory infections”

Should there be some kind of incentive to fill these positions?
In Castile and Leon we talk about the possibility of traveling to work on certain days from Madrid, for example to Valladolid. These new ways of working need to be encouraged to adapt to each professional’s situations. Moreover, rheumatologists may have a financial incentive to travel to more remote areas where there are fewer specialists. Currently, many rheumatologists work in private clinics.

How do new technologies help prioritize patients in a given specialty?
It’s still very green. For example, previously no one could imagine that we could use ultrasound, but now we need it. If we add to this all the techniques that allow us to see vascular lesions or vascular lesions, then the diagnosis is made much earlier. We may have suspicions, but there are no specific biomarkers, and with the help of an imaging method we can see what kind of lesion is present. Significant progress has now been made in the field of biomarkers and in achieving more personalized medicine.

“The most important task is to spread rheumatic diseases among the population and cooperate with patient associations”

Primary care physicians play a fundamental role in providing faster diagnosis. Do you now think they are sufficiently prepared?
It is necessary to know the difficulties that exist in primary health care and present our problems to them. The relationship with primary care has changed greatly in recent years. Previously, we practically didn’t talk to each other, they sent us a patient and we wrote a report. On the other hand, now we have quite good relations and we have improved in this joint work. There is still room for improvement in communication, and it is important to take advantage of the potential of virtual consultations and telemedicine.

What are the main tasks facing the specialty?
The most important task is to spread rheumatic diseases among the population and cooperate with patient associations, which are a very important part. Collaboration with patient associations and their participation in decision-making is of great value. Moreover, we are working to ensure that the situation in all autonomous communities is as similar as possible and that in some areas there are not such large shortages.