Though relatively new in terms of awareness and clinical practice, Rheumatology is an evolving area of interest in North-East India at present. Despite a heavy burden of Rheumatic diseases in NE India, there is a major shortage of Rheumatologists and a limited health literacy among people about Rheumatology and Rheumatic diseases.

We have very little data on rheumatic diseases from the North East, with inadequate large-scale research or randomized controlled trials despite a heavy disease burden. The prevalence of Systemic Lupus Erythematosus (SLE) in NE India is higher than the rest of the country, which might be attributed to the ethnic, genetic, and geographic diversity of the region. This part of India is home to many tribal communities with diverse food habits and cultural variations, which could be the reason behind the high disease burden of lupus. The prevalence of other connective tissue diseases (CTDs) like rheumatoid arthritis, systemic sclerosis, mixed connective tissue disease, Sjögren’s syndrome, inflammatory myositis, and seronegative spondyloarthritis spectrum diseases in the NE is also found to be similar to the rest of the country. We have observed that our RA and Sjögren’s patients exhibit a younger age of disease onset, but there is a significant lack of documentation and proper research. The prevalence of different types of vasculitis (small, medium, or large vessel vasculitis) is found to be comparatively rare, which may be due to underreporting rather than an actual absence of the disease. Many patients are not reported due to unawareness, inadequate diagnostic facilities, and fewer referrals.

There is a serious deficit of specialists , appropriate laboratory facilities and adequate infrastructure for training in Rheumatology in this region. A large number of primary care physicians and general practitioners ( GPs) lack awareness about rheumatology and the broad spectrum of diseases under its umbrella. Though awareness is gradually evolving in metropolitan cities, it still has a long way to go in remote villages and tribal areas.

Non-compliance and loss to follow-up are two major issues responsible for disease flares. In tribal areas poor socioeconomic background, limited accessibility to education and healthcare facilities leads to delay in diagnosis and treatment, and often a heavy dependence on alternative or herbal medicine. The high cost of investigations and advanced treatments like biologics also contribute to non-compliance and discontinuation of therapy. Even after diagnosis, there are other treatment challenges like the high prevalence of infections like tuberculosis in CTD patients. Over-the-counter steroid abuse is another issue which remains to be addressed.

Incorporating undergraduate teaching programs, creating adequate clinical vigilance among primary care physicians and GPs about rheumatological diseases is the need of the hour, so as to facilitate early diagnosis and initiation of treatment, thereby reducing significant morbidity and mortality and improving the quality of life of our patients. Sensitization of the public can be achieved by organizing health camps, outreach clinics, and distributing pamphlets and posters especially in remote and tribal areas.

Besides an increased number of rheumatology specialists, we also need adequate facilities to conduct large-scale research and maintain regional registries for our CTD patients, adequate infrastructure for rheumatology training, easily accessible and affordable laboratory facilities, and government-supported treatment schemes so that the diagnostic and treatment challenges can be easily overcome in NE India.