ODESA, UKRAINE – For many people, receiving a correct diagnosis—even for a chronic illness—can bring relief after months of unexplained pain and uncertainty. War makes access to effective treatment even harder, but determined teams of healthcare workers are proving it’s still possible.

This was the case for Oleksii Pigarev in January 2022, just weeks before the war in Ukraine began. The then 37-year-old long-distance coach driver could finally begin treatment for rheumatoid arthritis (RA), an autoimmune disease that had turned his everyday routine into a physical and emotional struggle.

“My back began hurting, I would wake at night, I couldn’t lie down and had to sleep in a chair,” said the resident of the Black Sea port city of Odesa, who makes his living taking passengers to and from Poland, hunched at the steering wheel for hours at a time.

Today, thanks to a concerted effort by Direct Relief’s local partner organizations and health practitioners in Ukraine, Oleksii and thousands of others living with rheumatic diseases, including many children, can better manage their symptoms.

In recent months, Direct Relief has delivered large quantities of anti-rheumatic medications to partner organizations across Ukraine, with plans to continue providing support.

Protecting the Human Body Against Itself

Rheumatoid arthritis is one of several autoimmune conditions in which the body’s immune system mistakenly attacks the joints, causing pain, swelling, and stiffness. Over time, it can damage cartilage and bone. While there is no cure, early diagnosis and consistent treatment with disease-modifying anti-rheumatic drugs (DMARDs) can significantly reduce symptoms and help prevent long-term damage.

The World Health Organization estimated that 18 million people worldwide were living with RA in 2019. Women are disproportionately affected, comprising around 70% of cases, and more than half of those diagnosed are over the age of 55. However, children can also be affected. As of 2024, 2,218 Ukrainian children were registered with juvenile idiopathic arthritis (JIA), a form of RA that can, in some cases, improve with age but may affect bone development.

In Oleksii’s case, his diagnosis was sidetracked by the appearance of itchy, scaly patches on his scalp and elbows. This was taken for psoriasis, and he was initially referred to a dermatologist and not a rheumatologist. However, psoriatic arthritis also causes skin outbreaks, is very similar to RA, and is generally treated in the same way.

“Psoriasis is an indicator of rheumatism in about half of cases,” said Dr. Leonid Kholopov, a specialist at Odesa’s Clinical Medical University who sent Oleksii for further tests before RA was confirmed.

Pooled Resources Improve Diagnosis and Medicine Supply

For nearly two years after his diagnosis, Oleksii had to privately purchase a prescribed drug that created a heavy financial burden by local standards. Pigarev paid out of pocket for medication—an ongoing financial burden. While the treatment helped, inflammation and pain persisted. Dr. Kholopov recommended another medicine, but its high cost put it out of reach.

Oleksii approached the humanitarian center of Direct Relief’s core partner in Odesa, Ukrainian Soul, to see if they could help. The center, called Hospitable Hut, purchased the drug for him from its discretionary funds, changing his life. “[The medicine] stops the inflammation, which in turn stops the pain,” said Oleksii. “I sleep well now, and it’s easier to move.”

After observing the local need, Ukrainian Soul sent a request to Direct Relief for supplies of the medication, which began arriving in 2024. This alleviating pressure on the local health service, which also caters to around 200,000 internally displaced persons.

“Cities usually have governmental programs in supplying people with [anti-rheumatic drugs], but it doesn’t work well during war. Many people are left without support, in Odesa in particular,” said Oleksandr Cherepanov, partnership and distribution coordinator at Ukrainian Soul. “They don’t have funds to cover all people, so we help them fill the gaps.”

Reaching More Patients

As awareness grew, more patients began receiving donated medicine. Each package provides one month of treatment, and Hospitable Hut has supplied at least 15 patients with six-month stocks.

One recipient was 25-year-old Diana Tel’pis, who, after years of living with psoriasis, was finally diagnosed with RA in 2023, just as she was graduating from medical school. This changed her outlook on life, including her career path: Diana is now specializing in rheumatology at the Clinical Medical University. “Because I was sick myself, I decided this was the right course to take. I understand the patients better as a result,” she said.

In mid-March, Hospitable Hut provided several months’ supply of the drug to Odesa’s Primary Health Care Center №4, which, with five other city clinics, has 195 rheumatic disease patients on its register who require two shots of the medicine a month. Another consignment was sent to health authorities in the adjacent Mykolaiv region, which, like Odesa, has been heavily war-affected.

The medication is one of several similar treatments dispensed free of charge by Center №4. Administered with a special injecting pen, it proved effective for 25 of 38 children living with JIA. It is also well suited for 103 of 121 patients living with ankylosing spondylitis, another autoimmune disease that causes inflammation in the joints and ligaments of the spine.

Center №4 reports a sharp rise in the number of registered patients with rheumatic diseases in Odesa, more than doubling from 97 last year.

“There are more and more patients every week,” said Center №4 director Tetyana Chernenko.

To help meet the growing demand, Hospitable Hut received seven additional crates of anti-rheumatic medicines from Direct Relief’s warehouse in Santa Barbara, California, on May 2. Two larger shipments are also en route to partner organizations in eastern Ukraine.

Direct Relief has provided more than $1.8 billion in medical aid, including more than 374 million defined daily doses, to health organizations responding to the conflict in Ukraine.