The following is a summary of “A Mixed-Methods Systematic Review on Syndemics in Rheumatology,” published in the April 2023 issue of Rheumatology by Flores, et al.
For a mixed-methods systematic review, researchers sought to assess the use of the syndemic framework and corresponding methodology in documenting syndemics and their impact on rheumatic and musculoskeletal diseases (RMDs).
The Joanna Briggs Institute, Cochrane Collaboration, and PRISMA guidelines were followed to search, retrieve, revise, and analyze studies that used the syndemic framework approach for RMDs, published from January 2003 to January 2021.
A total of 658 potential articles were identified, and after a full-text review, only 4 studies were included – 2 quantitative, 1 qualitative, and 1 mixed-methods study. Network analysis in the first study found that RMDs were associated with comorbidities, unhealthy habits, low educational level, living in rural areas, socioeconomic conditions, and health inequality in indigenous communities. The second study used SSEM and cluster analysis to demonstrate an association between low back pain and factors such as comorbidities and indigenous status in urban/rural communities. The qualitative study examined three generations of fishing families and reported lower syndemic vulnerability. The mixed-methods study focused on osteoarthritis with multimorbidities in an African American population, where a lack of education added to worsening outcomes.
Although the syndemic framework approach has given important insights into other nonrheumatic diseases, its use in rheumatology was scarce. The complexity of the clinical and social determinants related to RMDs made it necessary to conduct further studies from a syndemic perspective.
