AB0808 A SYSTEMATIC REVIEW ON SYNDEMICS IN RHEUMATIC AND MUSCULOESKELETAL DISEASES (RMDs)
Authors: M. F. Ramirez-Flores, C. Cadena-Trejo, D. Alpizar-Rodriguez, V. Fernandez-Garcia, A. Gastelum-Strozzi, A. Hernandez-Garduno, I. Peláez-Ballestas
Journal: Annals of the Rheumatic Diseases (2021)

Background: Syndemics comprises the interaction of two or more biological diseases in different socio-cultural situations and in the context of varying healthcare standards that exacerbates their deleterious effects on the health of individuals, communities, and societies (1). There is increasing interest in using syndemics in the study of RMDs. Objectives: To identify quantitative and qualitative RMDs studies focused on syndemics through a systematic review and synthesize the available evidence. Methods: Inclusion criteria were using a syndemic framework in methods in RMDs studies. A systematic search of studies published from 2003 up to January 2021 was conducted in two electronic databases (SCOPUS and Web of Science). The systematic search was implemented (Figure 1): 1) the word syndemic(s) was searched using the advanced query string search, in the title, abstract, keywords, and text, to identify the relevant studies; 2) the publications were screened by three peer review groups; 3) the group evaluated each title and abstract and reviewed full-text articles to identify those relevant for review; 4) synthesis focused on identifying the variables of each study and integrating findings. Results: The initial search yielded 658 unique articles, from which ten studies were identified as syndemics in RMDs. After full-text review, six studies were excluded due to not inclusion of a syndemic framework. Four studies were included (Figure 1). The first quantitative study was on eight Latin-American (LatAm) indigenous communities (n=6,155). RMD´s were highly prevalent in the indigenous people (34.5%), RA prevalence was 2.4% in the Qom group of Argentina, and low back pain (LBP) being the most prevalent RMD (13.3%). RMDs were strongly associated with other comorbidities, unhealthy habits, low education levels, rural areas, socioeconomic conditions, and health inequality. The network analysis was the analytical approach using the Syndemic and Syndemogenesis Elements Modeler (SSEM). The second quantitative study focused on six urban/rural LatAm countries (n=55,724). LBP was significantly associated with comorbidities, unhealthy habits, low educational level, rural areas, and indigenous status. SSEM and cluster analysis showed a significant association between LBP prevalence and social variables. One qualitative study in fisher rural families (n=7) with three fisher rural generations from the Netherlands. A case study using life course theory. The first two generation reported syndemic vulnerability (psychological distress, cardiometabolic conditions, or musculoskeletal pain), and the third generation report less syndemic vulnerability, including musculoskeletal pain. A mixed study was identified focused on osteoarthritis with multimorbidities (cardiovascular, hypertension, diabetes mellitus) in an African American population (n=110) in the USA. The methodology was a descriptive secondary analysis and qualitative interviews. The study found that patients with hypertension (80.9%) reported greater chronic pain than those without. The lack of education added to the incorrect use of nonsteroidal anti-inflammatory drugs might contribute to the worst outcomes in this population, a significant burden of cardiovascular disease. Conclusion: There is growing interest and urge for integrating syndemics in the study of RMDs. This review has demonstrated that there are only a few publications to date. The statistical power and the analytical approach (SSEM-Syndemic and Syndemogenesis Elements Modeler) in the two quantitative studies are relevant. The qualitative study demonstrated less syndemic vulnerability with better health conditions linked to better socioeconomic advantages. The mixed qualitative study did not show a syndemic framework. It is necessary to carry out studies in RMDs from the syndemic perspective to document the complexity of the clinical and social determinants related to these diseases. References: [1]Singer M, Bulled N, Ostrach B, et al. Syndemics and the biosocial conception of health. The Lancet 2017;389:941–50. Disclosure of Interests: None declared