Jornal Médico – Rheumatic diseases: the horizon to 2030

Jornal Médico – Rheumatic diseases: the horizon to 2030

The new National Health Plan (PNS) will be released soon, and the action will continue until 2030. The document was criticized by Luís Cunha Miranda from the Portuguese Institute of Rheumatology, who revised it, noting the chapters on rheumatic and musculoskeletal diseases. Read opinion articles.

There is a new National Health Plan (PNS) to be released soon, with a time span of 2030, around 300 pages of guidelines will be used to improve the health of Portuguese people, with clear strategies and goals taking into account the impact of different diseases, Both in terms of mortality, but also in terms of disability and quality of life.

Life expectancy in Portugal is said to be increasing all the time, but in the last years of life our elderly are among those with a poorer quality of life in those years. Rheumatism and musculoskeletal disorders (RMDs) are among the diseases that affect older adults and are the leading cause of this loss of quality of life. It is with this assumption that I review PNS 2021-2030, trying to envision which strategies go beyond reducing mortality from certain diseases, a strategic vision for aging and disability.

The first nearly 200 pages are about indicators and frameworks, from demographics to drinking water access to COVID-19 (I ignore its relevance to 2030).

However, throughout the document, we learn that the DGS and its experts managed to invent concepts and terminology not used by the rest of the medical community. MRD, possibly just a rheumatic disease, started being called a musculoskeletal disorder in Portugal, and there was a serious error in concept and nomenclature. But we also know from interesting data that these diseases are the most disabling diseases and that they increased significantly from 2009 to 2019.

So DRM is in Disability Adjusted Life Years (DALYs)It was the disease with the largest increase from 2009 to 2019. Adding back pain, also MRD, increased by 16.5%, equivalent to 7% of the total DALYs for all diseases, making it the largest disability.

If relevant, we link the analysis of disease and disability burden Years of Life with Disability (YLD) Among them, DRM increased by 33.1% from 2009 to 2019, and various DRM stood out in this disease burden indicator (1st back pain, 6th osteoarthritis, 7th other diseases musculoskeletal diseases, 10th neck pain), corresponding to 21.7% of all YLDs overall, and post-depression disorders had an impact of 6.8%, or 1/3 of the impact of DRM.

We can say that MRD is the disease with the fastest growing impact on DALY and YLD, nonetheless they are neglected and reduced in national health strategies whose priorities do not align with the impact on sustainability or the strategic vision for health to 2030 plan.

There are some situations in PNS that have been caricatured, and it does not reflect hall exist. So in the document, we exaggerate two important pathologies, but their actual impact is getting smaller and smaller.

There is a passage in the document: “Tuberculosis and HIV infection should also be taken into account because, although their incidence is declining, they are still of a relative magnitude.” DGS makes political rather than technical assumptions because of the HIV or tuberculosis has a significantly lower mortality rate and less impact than rheumatic diseases such as rheumatoid arthritis, psoriatic arthritis, fracture osteoporosis, or lupus. (SLE). As such, its scale derives from specific country programs and media visibility present in the DGS, rather than real economic, social, mortality or other impacts. In fact, an increase in sexually transmitted diseases other than HIV has been reported that is not considered in specific strategies to reduce these diseases. Although feasible, hepatitis C eradication has also not been considered.

Clearly, reducing mortality from several tumors and cardiovascular events or diabetes should and is a national priority in the PNS, but leaving aside multiple rheumatic and non-rheumatic pathologies, we are repeating the formula of the last century and driving what is about to become the world’s The population of one of the oldest five is experiencing painful aging and a lack of quality of life.

DGS experts are drawn from the coordination of sectoral programs that have the effective value of visibility, but also access to program funding, with no program quotas, meaning millions of available programs have been dominated by a few for years of disease. .

When assessing PNS, no adjustment was made for MRD and other conditions not related to mortality (eg, neurological or mental health) for potential negative disability and disease burden, which has implications for health resources, access, direct and indirect costs, and future of the system. sustainability. Among the diseases with low associated mortality, the two diseases with the lowest disease burden compared to Alzheimer’s disease, depression, SLE or rheumatoid arthritis were “selected”.

Finally, given that there are 12 priority projects and 11 non-priority projects, it remains to ask the DGS why the passage of the National Rheumatology Program (PNCDR) started in 2004 as a priority and ended in 2014 with no recovery. . Perhaps in this decision it was found that DRM was the disease with the greatest increase in impact, as the PNS identified in its text.

We live in an era of great technological and scientific needs, but also facing issues such as the sustainability of SNS and social security, PNS must be a document with an intellectual character, with a vision for the future, especially technically and scientifically sound .The document, which will be released with little or no revisions, is just a health policy document, pressure groups at work, smart not expertValuing certain professions and health professionals at the expense of others who may be more qualified.

In the case of rheumatism, it is the PNS of musculoskeletal diseases, and therefore without joints, which indicates their severe rigidity and aversion to movement and cessation of change, waiting for an aging without mass but full of impotence.

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