Opportunities and challenges in rheumatology research in Central Europe

The Central European Congress of Rheumatology (CECR) has been organized by seven Central European countries: Austria, Croatia, Czech Republic, Hungary, Poland, Slovakia, and Slovenia. These countries have lots of similarities, but also differences, with respect to rheumatology research. In this paper, based on questionnaires, we wish to demonstrate achievements and difficulties in rheumatology research performed in our region.


Background
Central European countries have common geopolitical backgrounds and numerous similarities with respect to history and development including medical care and research. Here we will deal with the seven official organizers of the Central-Eastern Congress of Rheumatology (CECR): Austria, Croatia, Czech Republic, Hungary, Poland, Slovakia, and Slovenia. There are significant differences between the countries with respect to gross domestic product (GDP), organization of healthcare, and research funding.
In this brief review, we wish to describe the recent developments and present the current situation of clinical rheumatology and research in Central Europe. For this purpose, we sent out a questionnaire to the presidents of the national societies.

Some indicators of rheumatology care
In order to understand rheumatological research in these countries, first we should assess postgraduate training and the definition of rheumatologists. In some countries, such as Austria and Czech Republic, most rheumatologists are also internists. On the other hand, in Hungary, about 70% of rheumatologists are not internists so many of them do not treat connective tissue diseases.
There are between 2 and 75 rheumatology hospitals/ departments in these countries. Where internists treat rheumatic patients, most outpatient and inpatient care is of course performed in internal medicine units. There are variable numbers of patients treated with biologics ( Table 1).
The seven countries have varying population numbers ( Table 1) so their relative share within the whole of Europe differs. However, the seven Central European countries took a significant share (3-4%) of abstracts submissions to recent EULAR congresses with an acceptance rate of 75-85%.

EWRR
The first European Workshop of Rheumatology Research (EWRR) was organized in London in 1981. The idea of the annual EWRR meetings was to give a platform to mostly young researchers to present their data in basic and translational rheumatology research. To date, 37 EWRR meetings have been organized. Among our seven countries, Vienna (twice), Warsaw, Prague, and Budapest have hosted EWRR congresses. An also increasing number of presentations from Central Europe has been included in the very recent EWRR meetings.

Problems to solve
Maybe with the exception of Austria, our countries have experienced a significant delay in the development of rheumatology research. For many years, only Austria and Czech Republic could be part of large international projects (e.g. BeTheCure, AutoCure). In many countries, research is very much centralized to the capital (Vienna, Prague, Ljubljana, Zagreb) or to nominated centres (Piestany). It is more evenly distributed among numerous university towns in Hungary and Poland. A major problem is lack of interest of young physicians in the field of rheumatology, as well as the large workload in routine clinical practice, leaving little time for research. With the advent of new therapies and novel molecular insights, this interest will hopefully rise again over the next years. Funding has been an issue and we hope that, with development, these countries could also participate in more EU-or EULAR-related projects. With respect to human resources, the "next generation" of rheumatologists is now slowly establishing itself in the international community.

Conclusion
Although, with the exception of Austria, these countries were socialist countries, significant development has been observed in rheumatology research.