Prevalence of rheumatic regional pain syndromes in Latin-American indigenous groups: a census study based on COPCORD methodology and syndrome-specific diagnostic criteria

What do we know about Indigenous Peoples with low back pain around the world? A topical review

BACKGROUND

Low back pain (LBP) represents a worldwide burden with rising disability, especially in low- and middle-income countries. Indigenous Peoples are exposed to many risk factors for LBP and seem to have overall worse health and higher mortality compared to non-Indigenous. This article aims to provide a topical overview of LBP in Indigenous Peoples.

METHODS

A comprehensive search was done using the keywords "Indigenous" and "back pain." Secondly, a cross-reference search of the citations list of the included articles was conducted.

RESULTS

LBP is a prevalent, disabling health condition among Indigenous Peoples that impacts activities of daily living, emotional well-being, and cultural identity. Indigenous Peoples face numerous and unique barriers to obtain Western health care. LBP in Indigenous Peoples is partly iatrogenic and available health care lacks a culturally secure setting. In combination with racism and discrimination by health care providers, this leads to miscommunication, frustration, and poor outcome in Indigenous patients around the world.

CONCLUSION

Contextual considerations and interpretation of findings within the appropriate cultural context are needed in future research and treatment of LBP in Indigenous Peoples. However, our literature analysis exhibits disproportionate representation with the scarcity of studies of Indigenous Peoples of Asia and Africa. Addressing this gap in the literature could provide significant scientific value. Indigenous Peoples should not be forgotten in reducing the global burden for LBP.

Pain Management of Amazon Indigenous Peoples: A Community-Based Study

Purpose

Indigenous peoples are vulnerable populations that live in remote areas of the Amazon forest with limited access to health-care services. Underreporting and undertreatment of pain is a common event in the general population but little is known about these issues in indigenous peoples. The aim of this study was to investigate the characteristics and cultural aspects of pain management in five ethnicities of the Brazilian Amazon.

Materials and Methods

Cross-sectional study carried out with adult indigenous individuals from five ethnicities of the Brazilian Amazon over two scientific expeditions (June–July/2017 and February–March/2019). Pain assessment included etiology, intensity, duration, aggravating and alleviating factors, body location, impact of pain on activities of daily living, and treatment.

Results

Ninety indigenous individuals with a mean age of 41.42 ± 19.59 years (range 19‒98 years) and median age of 37 years participated in the study. Sixty-four individuals (71.1%) reported experiencing pain at the time of interview with intermittent musculoskeletal pain of strong intensity being the more prevalent (back pain: 45.3%, joint pain: 43.7%) followed by headache (26.5%). The main alleviating factors reported were traditional indigenous medicine (21.0%) and rest (30.0%), and physical exertion was the main aggravating factor (69.0%). Most study participants reported that pain affected their mood, activities of daily living, and sleep and that they used both traditional indigenous medicine (78.0%) and conventional medicine (81.0%) for pain relief.

Conclusion

Musculoskeletal pain is prevalent among indigenous individuals, affects their quality of life, and is partly attributed to their lifestyle. Cultural aspects mediating the pain experience were observed. Traditional indigenous medicine for pain relief remains partially preserved among the ethnic groups investigated. The findings of this study can help improve the delivery care to these vulnerable populations.

Prevalence of inflammatory back pain and radiographic axial spondyloarthritis in a semi-urban community of Lahore, Pakistan

AIMS

To determine the prevalence of inflammatory back pain (IBP) and radiographic axial spondyloarthritis (SpA) in a semi-urban community of Lahore, Pakistan.

METHODS

This cross-sectional household survey was designed as per the Community Oriented Program for the Control of Rheumatic Diseases (COPCORD) model. In Phase 1, the subjects were interviewed for musculoskeletal (MSK) pain in the last 7 days by clinical assistants. In Phase 2, physiotherapists identified subjects with spinal/back pain and interviewed for Assessment in Spondyloarthritis International Working Group (ASAS) criteria for IBP. In Phase 3 subjects having IBP or chronic back pain (CBP) with an age at onset ≤45 years, were assessed and further investigated.

RESULTS

A total of 4922 subjects with a mean age of 35.3 ± 14.5 years, including 2770 (56%) women were surveyed in Phase 1. MSK pain in last 7 days was reported by 1407 (28.6%) of whom 1034 (21%) had spinal pain. The ASAS criteria for IBP were met in 329 (6.7%, 95% CI 6.0-7.0). In Phase 3, 222 with IBP and 83 having CBP with age at onset ≤45 years were evaluated. Out of this total of 305, 144 (2.9%) were confirmed to have IBP by rheumatologists as per at least 1 of the 3 criteria. ASAS criteria were met in 107 (2.2%, 95% CI 1.8-2.6). ASAS criteria for radiographic axial SpA were met in 47 (1%, 95% CI 0.7-1.3) of the surveyed population.

CONCLUSION

Inflammatory back pain was reported in 6.7% by physiotherapists, confirmed in 3% by rheumatologists. The prevalence of radiographic axial SpA was 1%.

High frequency of rheumatic regional pain syndromes in first-degree relatives of patients with rheumatoid arthritis

First-degree relatives (FDR) of patients with rheumatoid arthritis (RA) have a higher risk for the development of RA. In the stages prior to the development of arthritis, nonspecific musculoskeletal (MSK) manifestations may occur. The aim of the study is to describe the frequency of rheumatic regional pain syndromes (RRPS) in FDR of RA patients. A cross-sectional study was carried out from July 2016 to September 2018. Parents, offspring, and siblings of RA patients completed the Community Oriented Program in the Rheumatic Diseases (COPCORD) questionnaire. Rheumatoid factor (RF) IgG, IgM, and IgA; anticitrullinated peptide antibodies (ACPAs); C-reactive protein (CRP); and erythrocyte sedimentation rate (ESR) were determined. All subjects with a positive COPCORD (defined by the presence of musculoskeletal pain) were evaluated and classified. Three hundred thirty-five FDRs participated, 75.8% were female, mean age of 44.15 years; 138 (41.2%) were diagnosed with at least one RRPS; 72 (21.5%) had rotator cuff tendinitis, 51 (15.2%) pes anserine bursitis, and 39 (11.6) lateral epicondylitis; RA was diagnosed in 24 (7.16%) subjects, undifferentiated arthritis (UA) in 30 (8.9%) and inflammatory arthralgia (AI) in 104 (31%). We found anti-CCP positivity in 6.8%, RF IgA in 22.3%, RF IgM in 48.6%, and RF IgG in 8.9%. The presence of RRPS was higher in this RA-FDR group compared to general population. Clinical evaluation of this risk group should include screening for RRPS.

[Damage to periarticular soft tissues in real clinical practice: frequency, nature, effectiveness of non - steroidal anti - inflammatory drugs]

Damage to periarticular soft tissues is a common pathology that causes severe pain and impaired function of the musculoskeletal system.

AIM

To determine the frequency, nature and clinical features of damage to periarticular soft tissues in real clinical practice, as well as the effectiveness of non - steroidal anti - inflammatory drugs (NSAIDs) in the debut of treatment of this pathology.

MATERIALS AND METHODS

During the observational study, the frequency of defeat of the periarticular soft tissues in the structure of visits to 68 outpatient orthopedic surgeons in different cities of Russia for 1 month was estimated. Assessed the nature and dynamics of clinical manifestations during treatment in 1227 patients with defeat of the periarticular soft tissues. NSAIDs, mainly the original meloxicam, were used as a "first line" treatment for damage of the periarticular soft tissues. The results of treatment were evaluated after 10-14 days at a repeat visit of patients.

RESULTS

The proportion of patients with damage of the periarticular soft tissues was 15.8% of the total number of people who applied for outpatient care. Among 1227 patients (men 57.5%, average age 51.3±15.5 years) who were observed in the dynamics, prevailed were those with damage of the periarticular soft tissues of the knee joint area (knee joint enthesopathy, prepatellar bursitis, tendonitis/ bursitis of the goose foot area) - 21.2%, feet (plantar fasciitis, calcaneal spur) - 16.9%, shoulder (tendonitis of the muscles of the shoulder rotators) - 16.4% and the elbow (lateral and medial epicondylitis) - 15.3%. During treatment, there was a significant decrease in the total severity of pain - from 6.58±1.61 to 2.48±1.60 points on an 11-point numerical rating scale (p.

Transcultural Adaptation and Validation of the Methodology of the Community Oriented Programme for Control of Rheumatic Disease (COPCORD) in the Indigenous Wayuu Population. Venezuela

OBJECTIVE

To adapt cross-culturally and validate the COPCORD methodology in the indigenous Wayuu population of Zulia state, Venezuela.

METHODOLOGY

A cross-sectional study was conducted on Wayuu indigenous people from the Mara and Guajira municipalities of the state of Zulia, Venezuela. The Venezuelan version of the COPCORD questionnaire was transculturally adapted and translated from Venezuelan Spanish to Wayuunaiki (Wayuu language). One hundred indigenous Wayuu, agreed to participate, they were administered the instrument, house by house, by health personnel, who were bilingual and previously trained. Positive COPCORD individuals were evaluated by rheumatologists. A descriptive analysis of variables was performed, Cronbach's alpha was measured, Spearman's correlation, screening test analysis (sensitivity, specificity, VPP and SVR+).

RESULTS

66% were women, average age 41.4years, 20% monolingual, 21% illiterate, 69% in a couple/married, 57% with informal work. Sixty-two percent reported pain, 56% with criteria of rheumatic diseases, the most frequent were: osteoarthritis (32.3%), mechanical lower back pain (13.9%), and regional rheumatic pain syndrome (12.3%). Five dimensions of the instrument presented Cronbach's alpha >0.7. The sensitivity was 100% and specificity 11.1%, VPP 14.3%, SVR+ 1.13%.

CONCLUSION

The COPCORD is valid and useful as a screening tool for the detection of musculoskeletal complaints and rheumatic diseases in the indigenous Wayuu population.

Mexican rheumatology: where do we stand?

The aim of this review was to provide an overall overview of the past, present, and future situations and main challenges that are facing Mexican Rheumatology as a medical subspecialty in the context of their national healthcare system, where a deficit of workforce at the national level coexists with a shortage of specialists in the less-developed southern states of the country and a great surplus of professionals within large metropolitan areas. We also analyzed the prevalence and burden of Rheumatic and Musculoskeletal Diseases (RMDs), the structural composition and distribution of Mexican Rheumatology, and the clinical profile of the Mexican Rheumatologist. Last, we examined comorbidities, education and training programs and one scenario for Mexican Rheumatology wherein the principal main threats and opportunities are determined.