Rheumatology International

, Volume 39, Issue 3, pp 417–429 | Cite as

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

  • Tsvetoslav GeorgievEmail author
  • Rumen Stoilov


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.


Bulgaria Rheumatology Vasculitis Osteoarthritis Rheumatoid arthritis Spondylitis Systemic lupus erythematosus Scleroderma Myositis Biologics 



ANCA-associated vasculitis


American College of Rheumatology


Anti-neutrophil cytoplasmic antibody


Bulgarian Rheumatology Society


Behçet’s syndrome


Chapel Hill Consensus Conference


Cartilage oligomeric matrix protein


Conventional synthetic disease modifying anti-rheumatic drugs




Disease modifying anti-rheumatic drugs


European Medicine Agency


European league against rheumatism


Food and Drug Administration


Giant cell arteritis




Inflammatory idiopathic myopathies


Large vessel vasculitis


Matrix metalloproteinase 3






National Center of Public Health and Analyses


National Health Insurance Fund


Non-radiographic axial spondyloarthritis






Proteinase 3


Rheumatoid arthritis


Ribonucleic acid


Systemic lupus erythematosus


Sjogren’s syndrome


Systemic sclerosis


Takayasu arteritis


Targeted synthetic disease modifying anti-rheumatic drugs


United States of America


Author contributions

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.


No funding was received for this study.

Compliance with ethical standards

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Conflict of interest

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


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Clinic of RheumatologyUniversity Hospital “St. Ivan Rilski”, Medical University-SofiaSofiaBulgaria

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