Mapping inequalities in rheumatology care in Europe: the first edition of the EULAR RheumaFacts project

To describe inequalities in health indicators relevant for quality of care to people with rheumatic and musculoskeletal diseases (RMDs) across Europe by comparing RMD health system indicators across European Alliance of Associations for Rheumatology (EULAR) member countries.

RheumaFacts is an EULAR initiative to improve the quality of care across Europe by monitoring access to and outcomes of care for people living with RMDs. In this study, we present the first edition of this longitudinal mixed-sources study initiated in 2024. A standardised form including indicators on RMD health resources and organisation, national workforce, and access to care was sent to the 40 National Scientific Rheumatology Societies who were EULAR members in 2024 was sent to the EULAR-member National Scientific Rheumatology Societies of 40 countries. Complementary data on the demographic and economic status of the various countries were extracted from open-source databases such as the WHO and World Bank datasets. Analyses were descriptive.

Standardised report forms were returned by 36 of 40 countries (90%). The density of rheumatologists ranged from 0.8 to 6.6 per 100,000 inhabitants (median, 2.9; IQR, 2.1-3.5) across the different countries. The reimbursement of nonpharmacological care on a chronic basis was limited: physiotherapy was reimbursed in 26 of 36 countries (72%), whereas psychological support was reimbursed in only 14 of 36 countries (39%). In 94% of the countries, all conventional synthetic disease-modifying antirheumatic drugs (DMARDs) were available. Despite all countries indicating the availability of at least 1 biologic DMARD, only 12 countries (34%) had access to all biologic DMARDs, and only 18 of 35 (51%) had access to all targeted synthetic DMARDs.

Wide cross-national inequalities exist in workforce capacity and reimbursed care for people with RMDs. RheumaFacts delivers the first harmonised basis for monitoring these gaps, enabling EULAR and national societies to track progress and inform health policy makers to advocate for improving the quality of life of people with RMDs.