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.

Keywords: COVID-19; comorbidities; epidemiology; health inequity; social determinants; syndemics.

Fig. 1

Syndemics and supersyndemics approach Using different methods to explain bio–bio and bio–social interactions can reveal syndemogenesis and provide information on the negative impact of the COVID-19 pandemic.

Fig. 2

The supersyndemic approach, defined as the bio–bio relation of RMDs with the COVID-19 pandemic, co-morbidities that aggravate RMDs, and the bio–social relation of social, economic, political and cultural parameters could provide information on the impact of the COVID-19 pandemic on care of RMDs.