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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
Review

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.

Keywords

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

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

Notes

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.

Funding

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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