Rheumatic diseases (RDs) encompass more than 100 conditions, ranging from osteoarthritis to systemic disorders; they remain a neglected burden in low-income countries, with shortages of specialists and fragmented systems undermining early diagnosis and disability prevention. Tajikistan, with a population exceeding 10 million but only 31 rheumatologists, exemplifies this challenge. The country's experience over the past 3 years demonstrates both the scale of the problem and the potential for modest, well-targeted interventions to catalyze systemic change 1. In Tajikistan, as in many low-income settings, these conditions are often underdiagnosed, misclassified, or recorded only when disability compensation is sought. Family doctors identify most cases, but their limited training in rheumatology leads to frequent misdiagnosis 2. Official statistics from the Ministry of Health and Social Protection of the Population (MoHSPP) show that between 2020 and 2022, the number of registered RD cases fluctuated between 7600 and 9600 annually. Rheumatoid arthritis, osteoarthritis, and gout were consistently the most prevalent conditions, while systemic lupus erythematosus and ankylosing spondylarthritis were leading causes of disability. These numbers capture only part of the burden; many patients rely on self-medication until disability forces care 3. In 2022, the Asia-Pacific League of Associations for Rheumatology (APLAR) awarded a COPCORD (Community-Oriented Program for Control of Rheumatic Diseases) grant to Tajikistan 4. The grant supported a pilot survey at Primary Health Center (PHC) in Dushanbe. Conducted early in 2023, the survey followed the COPCORD framework, with trained 38 nurses conducting door-to-door interviews and 11 rheumatologists providing diagnostic confirmation. Among 1190 volunteered participants, 327 reported musculoskeletal complaints. Osteoarthritis was the leading condition (46.8%), followed by rheumatoid arthritis (17.7%) and post-traumatic complaints (8.9%). None had received disability support, underscoring the gap between burden and protection. Beyond its immediate findings, the COPCORD survey revealed systemic weaknesses: poor healthcare-seeking behavior due to economic constraints, lack of awareness among family doctors, and absence of clinical guidelines for common rheumatic conditions. These insights were reported on the official event and reached policymakers, triggering broader action. In October 2023, the MoHSPP issued Order #317, mandating all PHCs to record rheumatologic indicators. This directive expanded the COPCORD framework from a single-center pilot to a nationwide monitoring system. By the end of 2023, 85 health centers had reported data, registering 12 143 patients with rheumatic diseases. Of these, 11.3% had confirmed disability. This represents the first comprehensive national dataset on rheumatic diseases in Tajikistan. It also demonstrates how a modest grant, when strategically implemented, and reported on a higher level can catalyze systemic reform. As it is presented in Figure 1, the COPCORD initiative not only provided epidemiological data but also stimulated the development of updated clinical guidelines, quarterly meetings of the Tajikistan Rheumatologist Association, and training courses for family doctors. Despite notable achievements, sustaining COPCORD-driven reforms in Tajikistan remains a complex task. The establishment of a national registry across 84 PHCs is a milestone, yet its long-term effectiveness depends on continuous monitoring, mentoring, and high-level communication. Progress in shifting policymakers' attitudes is encouraging, but without dedicated personnel and institutional support, momentum risks fading. The small group of rheumatologists is balancing clinical duties with advocacy, training, and collaboration with family doctors, while also engaging younger researchers to modernize the registry through digital tools and data protection standards. Tajikistan's COPCORD experience highlights several strategies that can guide both national sustainability and replication in other low-income countries. First, capacity-building must extend beyond rheumatologists: short training modules for general practitioners and mentorship networks can improve early detection. Second, sustainability of the registry requires digital integration, local ownership, and diversified funding, ensuring that data collection remains consistent and valuable. Finally, replication in other countries should begin modestly, embedding simple indicators into primary care and leveraging international partnerships for technical support. These steps demonstrate that even small investments, when strategically implemented, can catalyze systemic reform and improve patient outcomes. The trajectory from evidence to policy impact is clear, but maintaining reform will require resilience, investment, and integration of rheumatology into primary care to prevent regression. In low-income countries, where patients may remain invisible until disability strikes, the need for early detection and prevention is urgent. Tajikistan's COPCORD experience shows that progress is possible. What is needed now is sustained international support, such as APLAR Academy provides through training, research collaboration, and funding, to ensure that these gains are consolidated and expanded. The trajectory from evidence to policy impact is clear, but maintaining reform will require resilience, investment, and integration of rheumatology into primary care to prevent regression. This editorial documents how a pilot COPCORD survey in Dushanbe catalyzed national reform, leading to the first comprehensive dataset on rheumatic diseases in Tajikistan. It closes the COPCORD grant cycle by demonstrating tangible outcomes: improved awareness, policy action, and systemic change. This experience illustrates the importance of sustained collaboration to ensure rheumatology services in low-income countries are no longer invisible. Zumrad Khamroeva: principal Investigator, COPCORD Grant awardee, and lead author. Prepared all reports and drafted this publication. Suraiyo Shukurova: professor and Chief Rheumatologist of Tajikistan, ensured that the COPCORD study results were widely disseminated at decision-making levels, enabling nationwide joint syndrome enquiry and supporting the development of the national rheumatology database. Firuzajon Zoidova: co-researcher, collected data from primary healthcare centers across the country, standardized the information for analysis, and created the dataset repository. This work was supported by the Asia-Pacific League of Associations for Rheumatology (APLAR) through a COPCORD grant awarded in 2022. The authors declare no conflicts of interest. The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.
Khamroeva et al. (Sun,) studied this question.