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Bulgarian rheumatology: science and practice in a cost-constrained environment

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Abstract

Our aim was to appraise publications from Bulgaria, to assess their global impact, and to describe features and challenges unique to the rheumatology practice in Bulgaria characterized by stringent cost constraints. The Scopus database was queried on 25th July 2018 and data on the number of published documents, their Hirsch-indices and citations number were extracted. Published Bulgarian guidelines for the management of rheumatic diseases and the presented data on Bulgarian Rheumatology Society were identified based on prior knowledge of the authors. From all the identified 1082 document the most extensively researched areas were rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), osteoporosis, and osteoarthritis (OA). For the last five years (from Jan 2013 to 25th July 2018) the number of publications was 293. We found that Bulgaria’s international scientific collaboration in the field of rheumatology is focused on a handful of countries mainly from Europe. Although Bulgarian rheumatologists have access to costly biologic agents for treating their patients with rheumatic diseases, their funding may not be granted according to the current recommendations of European League against Rheumatism (EULAR) and national guidelines for the management of rheumatic diseases. Although the western world clearly dominates the production of scientific publications in rheumatology, Bulgarian rheumatology may present another perspective for diagnosis and management of patients with rheumatic diseases in a cost-stringent environment. Nevertheless, both rheumatology science and practice in Bulgaria still have a long way to go to take its deserved place among the other European countries.

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Abbreviations

AAV:

ANCA-associated vasculitis

ACR:

American College of Rheumatology

ANCA:

Anti-neutrophil cytoplasmic antibody

BRS:

Bulgarian Rheumatology Society

BS:

Behçet’s syndrome

CHCC:

Chapel Hill Consensus Conference

COMP:

Cartilage oligomeric matrix protein

csDMARDs:

Conventional synthetic disease modifying anti-rheumatic drugs

DM:

Dermatomyositis

DMARDs:

Disease modifying anti-rheumatic drugs

EMA:

European Medicine Agency

EULAR:

European league against rheumatism

FDA:

Food and Drug Administration

GCA:

Giant cell arteritis

h:

Hirsch

IIMs:

Inflammatory idiopathic myopathies

LVV:

Large vessel vasculitis

MMP-3:

Matrix metalloproteinase 3

MPO:

Myeloperoxidase

MSK:

Musculoskeletal

NCPHA:

National Center of Public Health and Analyses

NHIF:

National Health Insurance Fund

nrAxSpA:

Non-radiographic axial spondyloarthritis

OA:

Osteoarthritis

PM:

Polymyositis

PR3:

Proteinase 3

RA:

Rheumatoid arthritis

RNA:

Ribonucleic acid

SLE:

Systemic lupus erythematosus

SS:

Sjogren’s syndrome

SSc:

Systemic sclerosis

TA:

Takayasu arteritis

tsDMARDS:

Targeted synthetic disease modifying anti-rheumatic drugs

USA:

United States of America

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  1. Clinic of Rheumatology, University Hospital “St. Ivan Rilski”, Medical University-Sofia, Sofia, Bulgaria

    Tsvetoslav Georgiev & Rumen Stoilov

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  1. Tsvetoslav Georgiev
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Both TG and RS took part in the conception and design of the study, data management, analysis, and logical interpretation. TG drafted the article, while RS revised it critically for important intellectual content. Both authors read and approved the final manuscript.

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Correspondence to Tsvetoslav Georgiev.

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Tsvetoslav Georgiev declares that he has no conflict of interest. Rumen Stoilov declares that he has no conflict of interest.

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Georgiev, T., Stoilov, R. Bulgarian rheumatology: science and practice in a cost-constrained environment. Rheumatol Int 39, 417–429 (2019). https://doi.org/10.1007/s00296-018-4202-2

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