State of rheumatology in the Republic of Bulgaria for the period 2019 – 2023

Abstract

Over the past 15-20 years, there has been a notable shift in the overarching strategy within rheumatological theory and practice concerning the diagnosis and comprehensive treatment of rheumatic diseases. The primary focus has shifted towards early diagnosis, coupled with aggressive treatment strategies, aiming to achieve long-term remission or maintain low disease activity. Consequently, the primary objective for rheumatologists has been to achieve sustained improvement in patient outcomes.

This shift has been facilitated by the updating of classification criteria, enabling earlier diagnosis and intervention in rheumatic diseases. Furthermore, advancements in indices for evaluating disease activity and treatment efficacy have enhanced the monitoring process. The integration of new instrumental and laboratory techniques, such as Magnetic Resonance Imaging (MRI) and ultrasound (US) for musculoskeletal assessment, has become standard practice.

Additionally, the introduction of novel and highly effective treatments has significantly contributed to improved patient outcomes. Consequently, there has been a notable reduction in the proportion of patients experiencing disabilities associated with rheumatic diseases.

Nonetheless, a significant issue persists concerning the uneven distribution of rheumatologists and rheumatology hospital beds throughout the country. The disparity is striking, with over half of all rheumatologists concentrated in Sofia and Plovdiv, comprising 106 individuals (57 and 49, respectively). While there are economic, financial, and demographic factors at play, the primary root cause remains the absence of comprehensive government policies addressing this disparity.

In summary, the field of rheumatology in the Republic of Bulgaria has experienced considerable growth and transformation over the past decade. The number of rheumatologists has doubled, with a notable proportion exclusively engaged in outpatient care. This expansion has led to a commendable level of access to rheumatological specialists and hospital facilities per 100,000 population.