Rheumatic Diseases in Tunisia

Rheumatology in Tunisia has expanded in the last decades, with more than 220 specialists, including 142 females, practicing in the private and public sectors. The geographic distribution of rheumatologists needs to be more balanced in favor of coastal cities. More than ten hospital-university rheumatology departments provide practical training to students, residents, and paramedical staff in addition to health care activities. There are three centers of reference dedicated to pediatric rheumatology in our country. Our official rheumatology association is the Tunisian League Against Rheumatism (LITAR), established in 1975. Each year, the LITAR organizes the Tunisian Rheumatology Congress and the National Day of Rheumatology. Tunisians and foreign speakers, especially French and Maghrebians, present high-level scientific conferences, workshops, and updates. The first Biologic National Registry (BINAR), subsidized by the LITAR, was launched in 2018 and includes more than 500 patients treated with biological disease-modifying anti-rheumatic drugs (DMARDs) for rheumatoid arthritis and spondyloarthritis. Rheumatic and musculoskeletal disorders (RMDs) are prevalent in Tunisia, and their prevalence can reach one-third of the population. Extensive studies estimating the incidence and prevalence of chronic inflammatory rheumatism in our country still need to be conducted. Osteoarthritis is the most frequent disease. Post-menopausal osteoporosis is a widespread disease in Tunisia, as at least 16% of women over 50 have experienced one or more fractures. A strong partnership exists between rheumatologists, immunologists, genetic specialists, physical and rehabilitation physicians, orthopedists, internists, ophthalmologists, dermatologists, and gastroenterologists. The availability of musculoskeletal radiologists is limited, primarily due to their significant immigration to other countries. Thankfully, musculoskeletal ultrasonography is available in all rheumatology departments. Synthetic, biological, and targeted DMARDs are available in our country. Access to specific treatments requires enrollment in the national health insurance fund or an access program. Our four faculties of medicine provide 20 training programs related to rheumatology. The first postgraduate training program in pediatric rheumatology in Tunisia and the first Francophone program in Africa have been recently established. Furthermore, a master’s degree program has been introduced to provide training in ultrasonography.