This issue of The Lancet Rheumatology marks our first anniversary of publication, an occasion on which we are tempted to look back and celebrate the successes and achievements of the journal's inaugural year. But we shall resist this urge in favour of looking forward. In many ways, the situation for patients with rheumatic and musculoskeletal diseases is potentially worse today than it was a year ago. There is much work to be done.
The COVID-19 pandemic has disproportionately affected racial and ethnic minorities and has magnified pre-existing health-care inequities across the globe. It has also threatened to undo many of the recent gains in the treatment of patients with rheumatic diseases, leaving patients bereft of the routine clinical guidance and disease management they depend on to control their otherwise debilitating diseases. For many, this has meant increased pain, decreased function, irreversible joint damage, and substantially reduced quality of life. For others, diagnoses have been delayed by clinic closures and cancellations, decreasing the odds of achieving disease remission. And the hype over use of mainstay rheumatology drugs such as hydroxychloroquine for COVID-19 has engendered substantial anxiety and fear over access to and safety of these drugs among patients who depend on them on a daily (and long-term) basis.
Beyond the COVID-19 pandemic, huge inequities remain in patient access to specialty care and state-of-the-art therapies, particularly in low-income and middle-income countries (LMICs). Musculoskeletal diseases remain among the top contributors to global disability, accounting for 139 000 disability-adjusted life years in 2017, with negligible improvement since 2007. And these diseases are not confined to the elderly; an estimated 3 million children and adolescents worldwide are living with juvenile idiopathic arthritis, systemic lupus erythematosus or clubfoot alone, mostly in Asia and Africa—limited resource areas where rheumatology specialists are sparse and access to targeted therapies is mostly cost prohibitive. Indeed, children and adolescents with arthritis in countries with lower GDP are reported to have greater disease activity and damage, often associated with delayed referrals.
In the coming year, increased focus and resource allocation is urgently needed to begin to reverse the concerning trends in health-care inequities between resource-replete and resource-poor countries, and to improve access to specialty care for the most vulnerable patient populations. To this end, improvements prompted by the COVID-19 pandemic—in research efficiency, multidisciplinary collaboration, streamlined service provision, technology, and telemedicine—should, and must, be leveraged to improve patient care, strengthen health systems, increase awareness, and better understand the global burden of musculoskeletal diseases, particularly in LMICs. It is also imperative that we learn from successes and failures in the response to COVID-19, both to improve preparedness for future pandemics and to minimise the collateral health and economic damage caused by efforts to mitigate transmission of novel pathogens.
Journals have an important part to play in these efforts. The timely dissemination of high-quality data has perhaps never seemed more critical or been more challenging than during the COVID-19 crisis. As noted by WHO Director-General Tedros Adhanom Ghebreyesus, “We're not just fighting an epidemic; we're fighting an infodemic,” referring to the widespread dissemination of poor-quality data and misinformation around COVID-19. Many journals, including most of the Lancet family titles, have seen a huge increase in submissions, substantially increasing the demands on editors and peer reviewers. As such, we must continue to work toward improving and streamlining our editorial and peer review processes going forward, making sure to do so in ways that uphold the highest standards of quality and scientific rigor.
Although our sights are firmly directed forward, we would be remiss not to mark this occasion by thanking the many contributors to the journal over the past year, including authors, advisors, readers, statisticians, and clinical peer reviewers, who have served our nascent journal tirelessly and helped us to sow the early seeds of success. Peer review of our content has involved 370 researchers and clinicians, a remarkable 83% of whom have never declined a review invitation; 18 individuals have reviewed 5 or more times in the past year. We are grateful for your service, guidance, passion, and vision, and for allowing us to act as ambassadors of your work and the rheumatology community.
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