Interview: Velina Markovska
Assoc. Prof. Dr. Vladimir Kadinov is Head of the Department of Clinical Medical Sciences at Medical University - Varna and Head of the Clinic of Rheumatology at St. Marina University Hospital. Varna Clinic is the third specialized Clinic in Bulgaria after those in Sofia and Plovdiv, and currently it has 41 hospital beds. It receives patients from more than one third of the territory of the country (from Pleven and Ruse to Sliven and Burgas). More than 3000 patients suffering from inflammatory degenerative joint diseases, vascular - connective or autoimmune diseases are treated there every year.
The Clinic is accredited and with recognized Level III competence. It has modern equipment, utilizes innovations in the diagnosis of early rheumatoid arthritis and administers modern biological treatment every day through a specially appointed committee for granting expensive medications for these patients.
Assoc. Prof. Kadinov, what is rheumatoid arthritis?
Rheumatoid arthritis is an autoimmune disease whose incidence among the adult population in Bulgaria is about 1%. For comparison, in some countries, such as Great Britain and the Scandinavian countries, for example, about 7% of the people suffer from rheumatoid arthritis. It is defined as an inflammatory joint disease, with a tendency to affect almost all peripheral joints, sparing the spine. It has a chronic relapsing and progressive course, with relatively clear pathogenesis and clear diagnostic criteria.
What are the symptoms manifested by the disease?
The symptoms that should make patients more observant are symmetrical pain and swelling in the wrists, finger joints, feet, knees, ankles, lasting at least three months.
At what age are the first symptoms likely to be manifested?
It is a disease of the active middle age. Although the reason is still unknown, women more frequently suffer from it. The ratio is 3: 1, and patients suffer from it mostly within the decade 40-55 years of age. There are also children with rheumatoid arthritis, but they are very few. The disease most often begins with unusual morning stiffness in the arms or the small leg joints during the colder months of the year, accompanied by a swelling of one or more joints in specific places. This must necessarily lead the patient to a specialist - a rheumatologist, who will examine them and appoint the right tests in order to find out whether it is a case of first-rheumatoid arthritis or another type of arthritis.
What are the causes that can result in rheumatoid arthritis?
It is important to know that some factors can trigger the disease. These are infections, stress, genetic predisposition, geographical meteorological characteristics. In children with rheumatoid arthritis, for example, (especially if the disease is detected in the mother) there is a risk of inheriting the disease.
Is rheumatoid arthritis curable?
Over the last decade the disease has been treated successfully with the introduction of new disease-modifying drugs - biological drugs. The knowledge of the main symptoms of the disease by general practitioners is of particular importance so that patients could be directed to a specialist rheumatologist in due time, instead of going into a vicious circle from an orthopedist to a neurologist and vice versa.
It has been proven scientifically that if the treatment with disease-modifying drugs starts up to 6 months after the onset of the disease, the structural damage of joint system can be prevented and the functional capacity of the patient can be preserved. That is why the strategy "Treat to Target" has been introduced over the recent years.
What is the essence of the strategy "Treat to Target"?
It is a strategy for treating patients, requiring strong relationships between the patient, the GP and a specialist, and it aims to inhibit completely or bring the disease activity to a very low level. This strategy is a milestone in the treatment of rheumatoid arthritis.
What is the significance of rheumatoid arthritis as a disease?
Although rheumatoid arthritis is not recognized as a socially significant disease, when there is a person with rheumatoid arthritis in a family, in case of improper treatment this patient quickly reaches the stage of disability, which makes them unfit for work and as the process continues this leads to a distortion of their abilities to manage routine household chores. These patients become "a burden" both for their loved ones and for the country.
In this respect, the understanding of the significance of rheumatoid arthritis as a disease that often results in disability when improperly and unsystematically treated is absolutely crucial with a view to both preservation of the functional capacity of patients and the prevention of the loss of work capacity of these people. Rheumatoid arthritis is being successfully treated at this stage.
All doctors and patients should be aware of this, because the knowledge will prevent disability of thousands of Bulgarians. It is a crime, nowadays, when in Bulgaria there are specialists rheumatologists, applying the most advanced methods of diagnosis and innovative treatment, there to be patients with rheumatoid arthritis, who reach the stage of disability. Provided the disease is diagnosed in time, the prognosis is pretty optimistic.
Assoc. Prof. Kadinov, how many patients with rheumatoid arthritis are there in Varna?
It is very difficult to define their number precisely. Approximately 60 000 people suffer from this disease in Bulgaria, probably there are about 20 000 patients with rheumatoid arthritis in the region. About 1 000 people are treated at the Clinic in Varna every year.
What are the possibilities for early diagnosis of the disease?
In Varna region we have been conducting training of GPs for many years so far. Doctors in Varna and Burgas are well-trained, and they are able to direct patients quite accurately. Unfortunately, things are quite different in the regions of Silistra, Razgrad, Isperih, Dulovo, Rousse, Veliko Tarnovo, Targovishte, Dobrich. In these regions we need to focus our efforts and organize forums to train general practitioners on the specifics of the disease, so that they can properly direct their patients to a rheumatologist.