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

A syndemic framework assesses the multidimensionality of the interrelationships of diseases and their circumstances. This approach has given important insights into other nonrheumatic diseases.Objective: We aimed to assess the use of framework and corresponding methodology to document syndemics and its impact in rheumatic and musculoskeletal diseases (RMDs).Methods: Using a mixed-methods systematic review, studies using the syndemic framework approach for RMDs were identified and published from January 2003 to January 2021. The Joanna Briggs Institute, Cochrane Collaboration, and PRISMA guidelines were followed to search, retrieve, revise, and analyze.Results: A total of 658 potential articles were identified, but only 10 were initially eligible. After a full-text review, 4 were included. Following a full-text review, 2 quantitative, 1 qualitative, and 1 mixed-methods study were included. In the first, network analysis found that RMDs were associated with comorbidities, unhealthy habits, low educational level, living in rural areas, socioeconomic conditions, and health inequality in indigenous communities. In the second, SSEM and cluster analysis demonstrated an association between low back pain and factors, such as comorbidities and indigenous status, among others, in urban/rural communities. The qualitative study examined 3 fishing family generations and reported less syndemic vulnerability. The mixed-methods study focused on osteoarthritis with multimorbidities in African American population, where lack of education added to worsening outcomes.Conclusions: Even though the insights syndemic studies have given to other areas, its use in rheumatology is scarce. The complexity of the clinical and social determinants related to RMDs makes it necessary to conduct further studies from a syndemic perspective.