Recently, I was fortunate enough to interview someone from Germany who lives with rheumatoid arthritis (RA). I learned that there were some similarities in terms of the treatment and experience of RA in Germany, but also there were some significant differences when compared with having this condition in the United States. This interview piqued my curiosity about life with RA in other countries.
When my book, “Hard to Grip,” came out last year, news of it spread to Russia, where a medical professional who treats RA patients discovered it and recommended it to her patients and followers. I became interested in the RA experience in a country that is so different — from the weather to the government — from America.
I reached out to Daria Kusevich in Russia via Instagram (@kusevich_md), and she was kind enough to make herself available for an email interview. Thanks so much, Daria! I feel like these interviews help to globalize our RA community!
HealthCentral: Tell us a little about yourself. How did you get involved in rheumatology? What was your motivation?
Daria Kusevich: All of my life has been associated with medicine: My mother is a cardiologist. My sister is a neurologist. After graduating from Sechenov University, I was happy to study physician therapy at a clinic named after E. M. Tareev. My love for rheumatology was born here. Now, I’m working on a Ph.D. at the V.A. Nasonova Research Institute of Rheumatology.
HC: What are the most-common RA treatments you prescribe?
DK: In Russia, there are clinical guidelines and they are pretty much similar to the recommendations of EULAR (European League Against Rheumatism). Methotrexate is an anchor drug, and if it is ineffective, or people have an intolerance, our patients receive bDMARDs (biologics).
HC: I recently saw a documentary on a place in Russia that specializes in fasting — a form of dieting in which you do not eat at all for a period of time. This method has supposedly cured many people of RA. Have you heard of this? What are your thoughts on this treatment?
DK: Unfortunately, fasting really has a positive effect, because food is an important component in the mechanism of inflammation. This means only that you need to be attentive to the diet and look for and exclude the food that worsens your condition: casein, gluten, lactose, alcohol, caffeine. But, certainly, I do not recommend starvation!
HC: Are there any other treatments people try that you don't prescribe?
DK: Sure. People are always looking for miraculous healing methods. I do not prescribe hunger strikes to my patients, do not encourage homeopathy, dietary supplements, and herbal medicine. The basis should be DMARDs and other drugs in accordance with recommendations and medical protocol.
HC: As far as you know, are there any main causes of RA? What are your thoughts on this?
DK: This is the mosaic of autoimmunity. Triggers — starting development of RA — gather in a mosaic (including) heredity, genetics, smoking, infections, (and) social environment factors.
HC: How does healthcare work in Russia? Is it universally provided? Are medications provided and affordable for everyone, or do the prices of medication differ from person to person?
DK: Inpatient (treatment and examination) and outpatient care (examination and appointment of treatment without drugs) is provided to patients within the framework of compulsory health insurance — at the expense of the state. There are patients who belong to the group in need of social protection due to the fact that they can no longer work or even serve themselves. Then they are assigned a disability, and on this basis, they can receive free drugs for the treatment of RA. Able-bodied patients have to rely on themselves. In recent years some pharma companies have begun to offer patients their benefit programs for obtaining the needed drugs.
HC: Can you describe the rheumatology community? Is there support? In Russia, is RA well-known, or do you have to work hard to bring awareness and understanding to the public?
DK: The Association of Rheumatologists of Russia (ARR) unites all of us. It is an organization of great importance: guidelines for doctors and nurses, educational projects, support for young scientists, funding of internships and business trips. This is a living circulatory system with a heart — the V.A. Nasonova Research Institute of Rheumatology. Here began a patient community "Nadejda" (hope), with the support of ARR.
Of course, not everything is smooth, but our community is adequate and concerned for our patients and the specialty as a whole. Rheumatic diseases are not considered socially significant and it is a daily job to pay attention to the prevalence of inflammatory-joint pain and understanding their severity and insidiousness.
Each of us rheumatologists, as well as patients, need a voice, so thank you for this opportunity!