Background According to Fit for Work program, 3 technical tables -leaded by G. Minisola (clinic), F.S. Mennini (economic), G.Voltan (socio–political)- have been appointed in 2012 to promote musculoskeletal deseases as an health priority.
Objectives To verify if Italy is indeed the last one in the ranking of countries for musculoskeletal deseases treatment and the economic impact on the country-system.
Methods Registers of Italy, France, Ireland, Nederlands, Portugal, Spain, England and USA
Work: Survey on 375 patients – all with Rheumatoid Arthrytis (RA), Psoriatic Arthrytis (PSA) and Ankylosing Spondylitis (AS) – in 8 Italian Excellence Centers for diagnosis & treatment of Rheumatic deseases, showing all difficulties patients have to overcome in their professional relational and physical performance.
Costs: Rome Tor Vergata University study, elaborating data from INPS (Italian National Insititute for Social Provisions) on illness costs since 2009 to 2012.
Results RA italian cohort reaches the highest, 5.5, DAS28 score (Ireland 4.8, England&Portugal 4.2, USA 3.9, Nederland 3.1, Spain 2.9, France 2.5). It depends on several factors (illness duration, patients age, instruction/economic availability, punctuality in changing therapies), chiefly health system organization and waiting time to undergo a Rheumatologist inspection. 24,1% italian patients has severe disability (Ireland 8,7%, Nederland 10%, USA 9,5%, France 3.9%) and the same is for PSA, AS and Indifferentiate Spondylitis: BASFI indexes are respectively 4.27, 4.31, 4.19. Notice: After 1 year of therapy, >60% of patients with severe disability had BASFI decrease up to score <2.
Patients were 32% employees, 12% dealers&artisans, 11% generic, 7% specialized workers, 6% housewives&teachers. 51% work using PC; 48% perform repeated and frequent movements; 40% play manual activity. >50% was forced to leave work in recurrent way due the desease. In the 1st year from symptoms appearence on average patients loose 31 working days: 35 in RA, 27 in AS, 25 in PSA. Althought weight moving (36%), exposure to vibrations (10%), low temperatures (11%), high damp (14%), contact with liquids (12%) are rather low, people with Rheumatic deseases may fully perform their job on average only in the first 7 years from the desease beginning. Meaningfully, 45% is hardly stressed by job. 21%, even if manteining the same job, after some years can perform it in the same way, while 20% must totally change his working activity. PSA is less invalidating: 69% have no working limits, vs/ RA (51%) and SA (55%).
23 million working days/year are lost in Italy due to RA, PSA and SA. National Health Service supports only direct costs (30%): the remaining 70% (indirect costs, mainly loss of productivity) is on charge at Social System.
Conclusions In Italy Clinical Relief System is weak, as pointed by prof. Tuulikki Sokka (Rheumatology director, Jyväskylä Central Hospital – Finland), european reference for Rheumatic invalidating deseases. If Northern Europe –chiefly Finland– perfectly knows workability value as a parameter that can't be disregarded evaluating an efficient clinical and therapeutic approach, in Italy workability is not systematically measured. Best Practices are not standards to be used in all centers. Italian Rheumatologists will agree on this approach in the next years; it will be necessary to adjust health and economic system accepting the transformation challenge.
Disclosure of Interest None declared
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