Author(s): Chopra A, Patil J, Billempelly V, Relwani J, Tandle HS WHOILAR COP
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Abstract BACKGROUND: COPCORD (Community oriented program from control of rheumatic diseases) is a global initiative of the WHO/International League of Associations from Rheumatology (ILAR). The prevalence data from the first Indian COPCORD survey (Stage 1), carried out in village Bhigwan (Dist. Pune), in 1996, is presented. AIM: To study the rural prevalence of rheumatic-musculoskeletal symptoms/diseases (RMSD). METHODS: A cross-sectional survey of the village (non-randomised selection) was completed in five weeks, using validated questionnaires, served by 21 trained volunteers. 746 patients (18.2\%, 95\% CI: 17-1-19-4) were identified (Phase 1) from 4092 adults (response 89\%), and systematically evaluated (Phase 2 and 3) by a medical team, including a rheumatologist; limited investigations were carried out and diagnosis confirmed during a planned 12 week initial follow-up. Standard clinical criteria were used for the diagnosis; point prevalence estimates (prev)/confidence interval (CI) are shown in parenthesis. RESULTS: There was a dominant distribution of 'pain at all sites' (articular/soft tissues) in the females; painful neck (9.5\%), back (17.3\%), and calf (8.5\%) appeared significant when compared to the Bhigwan males and the Indonesian and the Chinese rural COPCORD results. 55\% RMSD were due to soft tissue rheumatism (5.5\%) and an ill-defined/unclassifiable symptom-related-diagnosis (7.1\%). Osteoarthritis (5.8\%) and inflammatory arthritis (IA) were seen in 29\% and 10\% patients respectively. 240 patients (5.9\%) with chronic knee pains did not show any clinical evidence of OA. The prev of rheumatoid arthritis (0.5\%, 95\% CI: 0.3-0.7), as classified by the American College of Rheumatology, was the highest ever reported from an Asian rural COPCORD study. Though unclassifiable IA (0.9\%, 95\% CI: 0.6-1.1) was seen, well defined reactive arthritis, TB, leprosy and connective tissue disorders were not observed. Gout was diagnosed in five patients (0.12\%). CONCLUSIONS AND DISCUSSION: The Bhigwan COPCORD survey demonstrates a significant rural spectrum of RMSD. It provides a reasonable speculation about the Indian rheumatological burden. Further, an eight year prospective study is in progress to identify new cases and risk factors, and educate people (Stages 2 and 3).
This article was published in J Assoc Physicians India
and referenced in Journal of Yoga & Physical Therapy