Syndemics & syndemogenesis in COVID-19 and rheumatic and musculoskeletal diseases: old challenges, new era

Abstract

People with rheumatic and musculoskeletal diseases (RMDs) are facing several challenges during the COVID-19 pandemic, such as poor access to regular health services and drug shortages, particularly in developing countries. COVID-19 represents a syndemic, synergistic condition that interacts with and exacerbates pre-existing diseases such as RMDs, other co-morbidities and social conditions. The emerging evidence on both biological and non-biological factors implicated in worse outcomes in people with RMDs affected by the COVID-19 pandemic, whether infected by the virus or not, calls for the need to use more novel and holistic frameworks for studying disease. In this context, the use of a syndemic framework becomes particularly relevant. We appeal for a focus on the identification of barriers and facilitators to optimal care of RMDs in the context of the COVID-19 pandemic, in order to tackle both the pandemic itself and the health inequities inherent to it.

COVID-19 vaccine safety and nocebo-prone associated hesitancy in patients with systemic rheumatic diseases: a cross-sectional study

“…Analysing also clinical and demographic data, we showed that vaccination was less attractive for patients that did not have university/college education. This is in line with a recently published study with similar setting [23], as well as with the emerging concept of "syndemics" which highlights that all aspects (including social) should be taken into account in the treatment of SRD patients, especially in the COVID-19 era [24,25]. Additionally, negative vaccination behaviour (defined here as not being vaccinated against influenza for the last 2 years), as well as nocebo-prone behaviour, has been strongly associated in our study with decreased rates of vaccination against COVID-19.…”

Association between social deprivation and disease activity in rheumatoid arthritis: a systematic literature review

“…Syndemic frameworks are one way in which this may be explored further, enabling the study of diseases using a mixed-methods approach to value the association between disease outcomes and multiple biological, psychological, social and other aspects, as demonstrated in the results of this review9 43 (figure 2).…”

Psoriatic Arthritis and Metabolic Syndrome: Is There a Role for Disease Modifying Anti-Rheumatic Drugs?

“…Whether these interventions can add to or modulate the effect of DMARDs on the MetS burden needs to be established. With the advancement of the syndemics framework for complex conditions (110,111), such an approach must be conceived in this scenario.…”