In the Dominican Republic, a deficit persists in the amount of rheumatology doctorswith the aggravating factor that the majority are concentrated in large cities, making patients Those who live in the most remote provinces may have to wait up to three months for a follow-up appointment.
“It is a need to open more places“said Paola Gottschalk, president of the Dominican Society of Rheumatologywhen consulted by Free Diary.
Another important aspect touched on by Gottschalk was the high cost of medications for rheumatoid diseases and eradicate the idea that they affect only one population aging, except for osteoarthritis, which is usually diagnosed in older adults.
“The conditions that are very inflammatory occur at a very young age, between 20 and 40 years, although they can affect any age, even the population childish. These conditions affect young and productive people,” said the rheumatologist who has her private practice in Santiago de los Caballeros.
“A father of a family, a young mother with a rheumatoid arthritis who can’t comb his hair, who can’t brush, much less can he go to work. Apart from not being able to provide, it also has very high costs of medicationswith a chronic condition, which will make him use this medication all his life, with prescriptions that often exceed the country’s minimum wage,” he explained.
Efforts must be directed at a early diagnosis and that adherence to the treatment.
“Rheumatological diseases are very varied, clinical manifestations They are also very varied. 80 or 90% of the diagnosis will be given by a good physical examination and a good clinical history, from there will come the laboratory tests and images”
The doctor indicated that pain in more than two joints, swelling especially in the hands, knees and feet, fever, general malaise, lack of appetite, fatigue, hair loss and some skin manifestations are the main symptoms. symptoms of a possible rheumatoid disease.
The rheumatoid arthritishe lupus erythematosusosteoarthritis, ankylosing spondylitis and fibromyalgia are the rheumatoid diseases of greatest incidence, being the inflammatory processes their common denominator.
Neurological manifestations
The neurological manifestations in patients with rheumatic diseases They have a high incidence rate. Up to 60% of people with lupus erythematosus have experienced neuropsychiatric disorders. 10% of the patients becomes diagnosed with psychosis.
According to the psychiatrist Alexandra Hichez, during her presentation “Perspectives of the mental health in the rheumatic diseases“, between 20 and 40% of patients with rheumatic diseasesas rheumatoid arthritissuffer from depression.
“This figure is significantly higher than the population general, where the prevalence of depression is approximately 7 to 10%,” he specified.
“Anxiety is also common in patients with rheumatic diseases. It has been reported that between 30% and 50% of patients with these conditions they experience anxiety disorders,” he added.
The proposal is for rheumatologists and psychiatrists to work “on a two-way street,” as part of a multidisciplinary management in patients where inflammation and chronic pain They become part of your daily life.
“No one is prepared to receive a diagnosis“, he highlighted, while emphasizing that the psychiatric disorders They are as similar and as important as the others clinical diagnoses.
Hichez said that the barriers to overcome are the treating doctors themselves, who do not dare to refer patients to patients to the psychiatrist; the patients by refusing to receive psychiatric help for fear of being labeled “crazy”; few scientific studies that support the importance of acting in a multisystem mode; social stigma and the cost of duality, since that same patient will be paying a treatment psychiatric and its medications for his rheumatic disease.
VII Dominican Congress
The specialists spoke within the framework of the celebration of the VII Dominican Congressorganized Dominican Society of Rheumatologyheld from October 17 to 19.
This edition was dedicated to the Dr. Mariella Bobadilla Pichardoin recognition of his more than 40 years of outstanding work and commitment in favor of the patients and in the medical community development Dominican.
The activity brought together prominent national experts and international to address the most relevant and current topics in the field of rheumatology, with the aim of continuing to strengthen knowledge and best practices in the field. treatment of rheumatic diseases.
