The Internet is a powerful media to disseminate knowledge for both scientific and lay people. Several official institutions of rheumatology have developed web sites for these purposes, outstanding those of the American College of Rheumatology (www.rheumatology.org), the International League of Rheumatism (www.ilar.org), and the RheumaNet in Germany [1].

In January 1996 the Spanish Society for Rheumatology (SER), understanding the potential of the new technologies for broadcasting the knowledge of this medical speciality, started a web site with the following purposes:

1. to provide information about rheumatic diseases to the general population,
2. to develop and give access to educational resources to the medical and patient communities,
3. to disseminate the scientific work produced by the members of its society, and
4. to keep members informed about the latest news related with their speciality.

Our site has a proprietary domain, and can be reached at http://www.ser.es

We are indebt with Bristol Myers Squibb for their patronage and support for this new service to the rheumatology community.

Spanish is the only language used in the entire web site. However, we plan to implement an English version progressively during 1999.

At this moment and as far as we know, this is the main official site to find information about rheumatology in this language in the Internet.

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Material & Methods

 The web site has been developed mostly by two of the authors (MB, IP) using standard web editors (Claris Home Page 3.0, FrontPage and Word 7.0) and several imaging programs (Photoshop 4.0, Corel Draw 7.0, GifAnimator, etc.).

The site is hosted in a Unix server in the IPS center of CTV (Centre Telematic Valencia, Spain) and updated periodically by authenticated FTP. This IPS acts as an Internet gateway with 34 Mbps in ATM mode.

There is a list of members of the Spanish Society for Rheumatology in a text-based searchable database (DB) in a password -restricted area of the same server. The DB can be queried by name and by location of the member(s) of interest. The search is performed by a CGI and results listed in a HTML page.

The list REUMA is managed by MB using a Listserv-based server located in RedIris, as described below.

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Sections of the website

The main sections of our website are:

• Society. Includes information from the Secretariat of the Society, Board of Trustees composition, goals of the society, and other basic information.
• News. Presents information extracted from the bulletin of the society, with grants and work information, and data about our current research projects.
• Agenda of Meetings and Congresses: Calendar of future scientific events complemented with reports of the participation of our society in international meetings.
• Links: A selection of relevant links to other resources in the Net regarding rheumatology, especially citing those in spanish.
• Directory of members. Database with personal data, accessible only by password to protect their right to privacy.
• Library. Contains links to online journals of interest in Rheumatology. A major point here is a complete list of summaries of our own Journal -Revista Española de Reumatologia- since 1995. Several full-text review articles are also included. We are currently working to implement a full-text version of the paper journal, starting 1999 onwards.
• Medical Education with extensive documentation regarding rheumatic diseases in plain spanish, which has been found very useful and easy to read for lay people.
  The diseases here covered are the most frequent types of arthritis, osteoporosis, fibromialgia, vasculitis, and autoimmune diseases including lupus erythematosus.

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 Site statistics

Current statistics for our website are:

• Total space used............. 6.1 MB
• Resources edited............134 HTML pages + 157 image files.
• Visits. In this 22 months of service we have received over 29.000 hits, in an ever-growing rate
  (11.200 in the last 5 months, averaging 80-120 daily).

According to NedStat statistics, 51% of the hits come from Spain, 14.6 from North and Latin-America and 29.5 are of unknown origin .

These statistics are summarised in the following figure and table.

Visits per World region 1. Europe 8659 57.06 %  2.  USA & Canada 1154 7.61 % 3.  .net y .org 559 3.68 % 4.  SouthAmerica 382 2.52 % 5.  CenterAmerica 235 1.55 %  6.  Asia 22 0.14 %  7.  Australia  10  0.07 %  8.  Africa  3  0.02 %   Unknown 4150 27.35 %

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The REUMA list

We also created a distribution email list to foster scientific rheumatology discussions. The list, named REUMA, is based in Listserv and product of a collaborative effort with RedIris, the main spanish center for scientific telematics development.

A description of the goals and philosophy of the list can be found in http://www.rediris.es/list/info/reuma.html

The list has now 163 subscribers (one fourth come from Latin-America) and manages 2-6 messages a day (227 in the last 6 months). Only health workers (doctors, nurses, physiotherapists...) are allowed to subscribe, to avoid disturbing questions from lay people. However, anyone can read the archives, which are located at http://listserv.rediris.es/archives/reuma.html

 In general, subscribers seem to have positive feelings about the list, and the rate of unsubscriptions is very low.

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 Future work and conclusion

 For the next year we plan to implement the following improvements in our information system:

• A full-text version of our scientific journal: Revista Española de Reumatología
• Integrate all resources (web, email) into a VCU (Virtual Community of Users), following the impulse given to this type of projects by RedIris (see http://www.rediris.es/cvu )
• Develop an English version of the main areas, especially the patient information area.
• Dinamize the news area, updating the information very frequently and coordinating it with the (paper) bulletin of the society.
• Improve de links section, with more resources and a quality rating for each of them.
• Start a clinical cases section, for online medical education
• If we can get financial support enough, we'd like to start an online medical consult system to solve clinical questions requested by rheumatic patients, from a professional point of view.
• The REUMA list will have several co-editors, to minimise the effort of keeping the list alive, and to stimulate more discussions.

Most of this projects will be possible only if two conditions are met:

• Financial support enough to keep stable a team of web master and editors.
• A working group committed to impulse actively the different sections of the web and email list.

References

 [1] Specker C, Richter J, Take A, Sangha O, Schneider M. RheumaNet -a novel Internet-based rheumatology information network in Germany. Br J Rheumatol 1998 Sep;37(9):1015-9

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