Epidemiology of rheumatic diseases. A community-based study in urban and rural populations in the state of Nuevo Leon, Mexico

Burden of Disease in Psoriatic Arthritis in Latin America: a Systematic Literature Review

INTRODUCTION

Psoriatic arthritis is a chronic inflammatory pathology that generates a substantial and progressive deterioration of functionality and quality of life. It is associated with comorbidities (cardiovascular and metabolic) and involvement of mental health. In Latin America, information regarding the disease is limited. This study reviews the burden of disease (disease activity, functional involvement, clinical manifestations, comorbidities, patient-reported outcomes, quality of life, and use of health resources) in PsA patients in Latin America.

METHODS

Systematic literature review of publications in PUBMED, EMBASE, Cochrane Database of Systematic Reviews-CDSR/Database of Abstracts of Reviews of Effects, LILACS, Scielo, Redalyc, conference abstracts, and grey literature. Two independent assessors selected studies and extracted information. Quality was assessed according to the type of study.

RESULTS

We identified 692 references, selecting 50 studies: 41 cross-sectional, four economic-studies, four cohort studies and one systematic review. The information comes mainly from Brazil, Argentina, and Mexico. The estimated disease prevalence for Latin America ranges from 0.004 to 0.08% (95% CI 0.02-0.20). Measurements with validated instruments suggest suboptimal assessment of disease domains, significant functional compromise, loss of productivity, and high frequency of comorbidities, including mental health. Methodological and population considerations limit the generalizability of the findings.

CONCLUSIONS

The available information reports a considerable burden of disease in patients with PsA in Latin America, with involvement of quality of life associated with disability in relation to disease activity and its various manifestations. Future research and funding efforts should be aimed at generating more standardized information about the impact of PsA in the region. Key Points •The functional involvement related to disease activity, the impact on the quality of life, and the frequency of cardiometabolic and psychological comorbidities are remarkable in Latin American patients with PsA. •The current synthesis offers an overview of the burden of disease (disease activity, functional involvement, clinical manifestations, comorbidities, patient-reported outcomes, quality of life, and use of health resources) in PsA patients in Latin America. •Future research efforts and clinical strategies are required in order to generate standardized data on the patients and better estimate the burden of disease in the region.

A systematic review of the global prevalence and incidence of shoulder pain

BACKGROUND AND OBJECTIVES

Studies reporting on the population burden of people living with shoulder pain show wide heterogeneity in terms of case definition, study samples, and occurrence. This systematic review aims to summarize evidence pertaining to the prevalence and incidence of shoulder pain, including variability based on sex and geography. We also explored the potential influence of methodological limitations and important sources of heterogeneity (case definition and reference period) on reported estimates of shoulder pain prevalence.

DATABASES AND DATA TREATMENT

The study protocol was registered on Prospero under CRD42021243140. We searched EMBASE, CINAHL, Web of Science and Medline from inception to March 2021. Study selection, data extraction and risk of bias assessment was conducted by a team of three researchers. We performed a narrative synthesis of the data, using forest plots to summarize study findings, and stratified data presentation to explore the potential association of risk of bias, case definition, and reference period with estimates of prevalence and incidence of shoulder pain.

RESULTS

We obtained data from 61 studies reporting data from high-, middle- and low-income countries. The overall risk of bias was low, with most rated as "low-risk" and no studies rated as "high-risk". The community prevalence of shoulder pain varied widely across the countries included in our review, with a median of 16% (range 0.67 to 55.2%). Longer reference periods were typically associated with higher prevalence estimates. Primary care prevalence ranged from 1.01 to 4.84% (median 2.36%). Estimates were generally higher for women than men and were higher in high-income nations. The incidence of shoulder pain ranged from 7.7 to 62 per 1000 persons per year (median 37.8 per 1000 persons per year). Risk of bias did not clearly explain variability in study findings, but there was considerable variation in study samples, methods used, and a relative absence of data from low-income countries.

CONCLUSIONS

Our review demonstrates that a significant proportion of the population across the world will experience shoulder pain daily, yearly, and throughout a lifetime. Regional gaps in evidence and methodological inconsistencies must be addressed in order to establish a more definitive global burden.

Low back pain prevalence, beliefs and treatment-seeking behaviour in multi-ethnic Suriname

Objectives

The aims were to determine, for the first time, the prevalence of low back pain (LBP) in urban and rural communities and to assess back beliefs and treatment-seeking behaviour in Suriname, a multi-ethnic country in the Caribbean community.

Methods

A cross-sectional community-based survey using the Community Oriented Program for the Control of Rheumatic Diseases methodology was performed between April 2016 and July 2017. Information was collected on LBP prevalence and LBP-related treatment seeking, beliefs about LBP [Back Beliefs Questionnaire (BBQ)], level of disability (Oswestry Disability Index) and the risk of developing persistent disabling pain (Start Back Screening Tool).

Results

A total of 541 out of 2902 individuals reported current acute or chronic LBP. It was more prevalent in urban (20.2%) than in rural (13.7%) communities, especially in females and older adults (>55 years of age). Individuals from rural areas [median BBQ = 18.00 (14.00-22.00)] had significantly more negative beliefs than the urban population [median BBQ = 25.00 (19.00-31.00); P < 0.001]. Maroons displayed more negative beliefs than Creole (P = 0.040), Hindustani (P < 0.001), Javanese (P < 0.001) and mixed ethnicity (P < 0.001) groups. At least 75% of the LBP population sought care, especially from a western health-care practitioner. Seeking treatment and having a higher risk of developing persistent disabling pain was significantly associated with more disability (P < 0.001). Age ≥45 years (P < 0.001), Indigenous ethnicity (P < 0.05) and functional disability (P < 0.001) were factors influencing treatment seeking.

Conclusion

Low back pain is a prevalent health problem in the Surinamese urban community, especially in older adults and among females. Most individuals experiencing LBP visited a western health-care practitioner and had more negative beliefs compared with other communities.

Prevalence, demographics, and clinical characteristics of Latin American patients with spondyloarthritis

Large epidemiologic and clinical estimates of spondyloarthritis (SpA) in Latin America are not available. In this narrative review, our goal was to descriptively summarize the prevalence and features of SpA in Latin America, based on available small studies. A review of peer-reviewed literature identified 41 relevant publications. Of these, 11 (mostly based on Mexican data) estimated the prevalence of SpA and its subtypes, which varied from 0.28 to 0.9% (SpA), 0.02 to 0.8% (ankylosing spondylitis), 0.2 to 0.9% (axial SpA), and 0.004 to 0.08% (psoriatic arthritis). Demographic and/or clinical characteristics were reported in 31 of the 41 publications, deriving data from 3 multinational studies, as well as individual studies from Argentina, Brazil, Chile, Colombia, Costa Rica, Mexico, Peru, Uruguay, and Venezuela. Data relating to treatment, disease manifestations (articular and extra-articular), and comorbidities were summarized across the countries. Available data suggest that there is a variability in prevalence, manifestations, and comorbidities of SpA across Latin America. Basic epidemiologic and clinical data are required from several countries not currently represented. Data relating to current treatment approaches, patient outcomes, and socioeconomic impact within this large geographic region are also needed.

Poor Sleep Quality Experience and Self-Management Strategies in Fibromyalgia: A Qualitative Metasynthesis

Poor sleep quality is a major concern and a highly prevalent symptom in fibromyalgia. We aimed to develop a metasynthesis of qualitative studies to assess how people diagnosed with fibromyalgia experience and manage poor sleep quality following the concepts of the Symptom Management Theory. The principles of metasynthesis established by Sandelowski and Barroso were utilized. A pre-planned comprehensive search was implemented in PubMed, Scopus, ISI WebofScience, and Cinahl Plus databases. The methodological quality was assessed following the CASP Qualitative Checklist. The findings of the studies were subjected to a metasummary and a metasynthesis. Seventeen studies were included in the metasynthesis. Two overarching themes were pre-established: (1) experience of poor sleep quality in Fibromyalgia and (2) poor sleep quality management strategies in Fibromyalgia. Four sub-themes emerged from the results: (1) evaluation of poor sleep quality, (2) response to poor sleep quality, (3) management strategies to favor sleep, and (4) managing the consequences of a sleepless night. Poor sleep quality is a severe and disabling symptom that negatively impacts the general health status of people diagnosed with FM. Prescribed treatments are commonly seen as ineffective and self-management strategies are a last resort and do not show beneficial effects.

Global Rural and Remote Patients with Rheumatoid Arthritis: A Systematic Review

Objective

Rural and remote patients with rheumatoid arthritis (RA) are at risk for inequities in health outcomes based on differences in physical environments and health care access potential compared to urban populations. The aim of this systematic review was to synthesize epidemiology, clinical outcomes, and health service use reported for global populations with RA residing in rural and remote locations.

Methods

Medline, Embase, HealthStar, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Cochrane Library were searched from inception to June 2019 using librarian‐developed search terms for RA and rural and remote populations. Peer‐reviewed published manuscripts were included if they reported on epidemiologic, clinical, or health service use outcomes.

Results

Fifty‐four articles were included for data synthesis, representing studies from all continents. In 11 studies in which there was an appropriate urban population comparator, rural and remote populations were not at increased risk for RA; 1 study reported increased prevalence, and 5 studies reported decreased prevalence in rural and remote populations. Clinical characteristics of rural and remote populations in studies with an appropriate urban comparator showed no significant differences in disease activity measures or disability, but 1 study reported worse physical function and health‐related quality of life in rural and remote populations. Studies reporting on health service use provided evidence that rural and remote residence adversely impacts diagnostic time, ongoing follow‐up, access to RA‐care–related practitioners and services, and variation in medication access and use, with prominent heterogeneity noted between countries.

Conclusion

RA epidemiology and clinical outcomes are not necessarily different between rural/remote and urban populations within countries. Rural and remote patients face greater barriers to care, which increases the risk for inequities in outcomes.

Oral health and orofacial function in patients with rheumatoid arthritis

The aim of the study was to describe the oral health and orofacial function of Mexican patients with rheumatoid arthritis (RA) and their association with clinical and radiological aspects of the disease. Patients with RA received a complete odontological exam, which also included a clinical and radiographic assessment of the temporomandibular joint (TMJ). The rheumatologic assessment included detailed profiling of the disease and serological and radiographic parameters. The study included 62 RA patients; the median (min-max) age was 51 (18-72) years old and 8.5 (1-39) years of disease duration. The 63.6% of the patients had DAS28 ≥ 3.2, and a median (min-max) of Sharp/van der Heijde score (SvdHS) of 41 (0-214). 98.3% of the patients presented caries, which were severe in 53.3% of the cases. The 73.8% of the patients were missing teeth due to caries, with a median (min-max) of 4 (0-32) teeth missing per patient. Oral hygiene was classified as bad in 49.1% of patients and only 15.3% of them had a healthy periodontium. The TMJ function was abnormal in 98.4% of the patients and 62.9% of them presented moderate or severe TMJ disorder (TMD). The radiographic damage of the TMJ correlated positively with the SvdHS. No correlations were found between disease activity or structural progression and orofacial variables, including periodontitis. There are severe oral and orofacial health problems in RA patients despite having medical attention for their disease. Multidisciplinary management remains an area of opportunity for both the medical specialists and the health system in our country.

Increased Risk of Myofascial Pain Syndrome Among Patients with Insomnia

Objective

The aim of this study is to evaluate the risk of developing myofascial pain syndrome among patients diagnosed with insomnia.

Methods

We conducted a population-based longitudinal study of a matched cohort with 7,895 participants (1,579 patients with insomnia and 6,316 controls) who were selected from the Taiwan National Health Insurance Research Database. The patients were observed for a maximum of 10 years to determine the incidence of newly diagnosed myofascial pain syndrome. A Cox regression analysis was performed to identify the risk factors associated with myofascial pain syndrome in patients with insomnia.

Results

During the 10-year follow-up period, 182 insomnia patients (14.9 per 1,000 person-years) and 379 controls (7.5 per 1,000 person-years) were diagnosed with myofascial pain syndrome. The incidence risk ratio of myofascial pain syndrome between the insomnia and control patients was 2.00 (95% confidence interval [CI] = 1.67-2.38, P  < 0.001). After adjusting for age, sex, monthly income, urbanization, and comorbidities, the insomnia patients were 1.93 times more likely to develop myofascial pain syndrome (95% CI = 1.62-2.31, P  < .001) than the control patients. Malignant neoplasm (hazard ratio = 3.08) and living in urban areas (hazard ratio = 3.05) were identified as independent risk factors for myofascial pain syndrome in patients with insomnia.

Conclusions

Patients with insomnia had a higher risk of developing myofascial pain syndrome than controls. This study adds to the understanding of the complex relationship between sleep disturbance and pain.

Prevalence of Disability in Patients With Musculoskeletal Pain and Rheumatic Diseases in a Population From Cuenca, Ecuador

OBJECTIVE

The aim of this study was to determine the prevalence of disability in patients with musculoskeletal pain and rheumatic diseases in Cuenca, Ecuador.

METHODS

We performed a cross-sectional analytical study with randomized sampling in 4877 subjects, from urban and rural areas. COPCORD (Community Oriented Program for Control of Rheumatic Diseases)-validated questionnaire was administered house-to-house to identify subjects with nontraumatic musculoskeletal pain and rheumatic diseases. The subjects were assessed by rheumatologists for diagnostic accuracy, and the Health Assessment Questionnaire Disability Index was administered to assess functional capacity. A logistic regression analysis was conducted to determine the association of rheumatic diseases with functional disability.

RESULTS

Functional disability was found in 221 subjects (73.1% women), with mean age 62 (SD, 18.2) years, residing in rural areas (201 [66.5%]), with education of 6.9 (SD, 5.3) years, and of low income (77 [47.2%]). The value of HAQ-DI was a mean of 0.2 (0-2.9). The real prevalence of physical disability was 9.5%. Moderate and severe disability predominated in activities such as kneeling (4.9% and 3.3%), squatting (4.8% and 2.7%), and leaning to pick up objects (3.7% and 0.9%), respectively. Rheumatic diseases associated with physical disabilities were knee osteoarthritis (95 [31.4%]) and hand osteoarthritis (69 [22.8%]), mechanical low-back pain (43 [14.2%]), fibromyalgia (27 [9.5%]), and rheumatoid arthritis (11 [3.6%]; P < 0.001).

CONCLUSIONS

Physical disability was associated with older age, female sex, rural residence, lower education, and lower income. Moderate and severe disability predominated in the dimensions of kneeling, squatting, and picking up objects. Rheumatic diseases associated with disability were hand and knee osteoarthritis, back pain, fibromyalgia, and rheumatoid arthritis.

TAKE HOME MESSAGE

Prevalence of fibromyalgia: literature review update

The present study aimed to update the literature review on the prevalence of fibromyalgia published in 2006. A bibliographical survey was carried out from 2005 to 2014 in the MEDLINE, Web of Science, Embase, LILACS and SciELO databases and 3274 records were identified. Five researchers selected the studies, following the inclusion criteria: studies that obtained the prevalence of fibromyalgia. Fibromyalgia studies in associated diseases were excluded. When screening by title and abstract, 2073 irrelevant articles were excluded. The full texts of 210 articles were evaluated for eligibility and this review included 39 studies, described in 41 articles. The selected studies were grouped into four categories: (A) prevalence of fibromyalgia in the general population; (B) prevalence of fibromyalgia in women; (C) prevalence of fibromyalgia in rural and urban areas; (D) prevalence of fibromyalgia in special populations. The literature shows values of fibromyalgia prevalence in the general population between 0.2 and 6.6%, in women between 2.4 and 6.8%, in urban areas between 0.7 and 11.4%, in rural areas between 0.1 and 5.2%, and in special populations values between 0.6 and 15%. This literature review update shows a significant increase in fibromyalgia prevalence studies in the world. The new 2010 American College of Rheumatology criteria have not been widely used yet and the COPCORD (Community-oriented program for control of Rheumatic Diseases) methodology has increased the quality of studies on the prevalence of rheumatic diseases in general.

Rheumatic Diseases in Chihuahua, México: A COPCORD Survey

BACKGROUND

Rheumatic diseases (RDs) represent a global problem for health care systems and patients. Community Oriented Program for Control of Rheumatic Diseases (COPCORD) is a low-cost screening tool for detecting musculoskeletal (MSK) pain and RDs.

OBJECTIVE

The aim of this study was to examine the pattern of MSK pain and RDs in clinic population in Chihuahua City, Mexico.

METHODS

A cross-sectional study was conducted in 7 primary health clinics using the COPCORD methodology in subjects older than 18 years. People with MSK pain not induced by trauma (positive cases) were evaluated by primary care physicians and rheumatologists.

RESULTS

The study included 1006 individuals with a mean age of 46.0 (SD, 15.8) years; 751 (74.7%) were women. Musculoskeletal pain in the previous 7 days was reported by 571 individuals (56.75%; 95% confidence interval [CI], 53.8%-60.1%), and 356 cases (35.4%; 95% CI, 32.5%-38.4%) were COPCORD positive. The mean pain intensity in visual analog scale was 6.62 (SD, 2.4). The most common painful joint was the knee (54.7%; 95% CI, 51.1%-59.0%). Two hundred eighty subjects with MSK pain (49.0%) previously sought medical attention, and 375 (65.7%) were under treatment. Functional impairment was reported by 69.8% of the COPCORD-positive subjects. The prevalence of RDs was 21.4% (95% CI, 18.9%-23.8%). The most prevalent disease was osteoarthritis (10.3%; 95% CI, 8.6%-12.4%), followed by regional pain syndromes (5.5%; 95% CI, 4.1%-7.0%), rheumatoid arthritis (1.4%; 95% CI, 0.8%-2.2%), and mechanical low-back pain (1.4%; 95% CI, 0.7%-2.2%).

CONCLUSIONS

Musculoskeletal pain is an important problem that affects our community. The data provided in this study will be presented to the local authorities to help in the development of prevention strategies.

Prevalence of musculoskeletal disorders and rheumatic diseases in Cuenca, Ecuador: a WHO-ILAR COPCORD study

The aim of this study was to determine the prevalence of musculoskeletal pain and rheumatic diseases in subjects over 18 years of age from the canton of Cuenca, Ecuador. Cross-sectional analytical community-based study was conducted in subjects over 18 years of age using the validated Community-Oriented Program for the Control of Rheumatic Diseases (COPCORD) questionnaire. Random sampling was used. The questionnaire was administered by standardized health workers. Subjects were visited house by house. Subjects positive for musculoskeletal (MSK) pain in the last 7 days and at some point in life were assessed by rheumatologists to confirm the diagnosis. A total of 4877 subjects participated, with an average age of 42.8 (SD 18.8) years of age; 59.7 % were women; 69.7 % lived in urban areas. 32.5 % reported MSK pain in the last 7 days and 45.7 % at some point in life. The prevalence of knee osteoarthritis was 7.4 %, hand osteoarthritis 5.3 %, low back pain 9.3 %, rheumatoid arthritis 0.8 %, fibromyalgia 2 %, gout 0.4 %, and lupus 0.06 %. Subjects from rural areas reported experiencing more MSK pain in the last 7 days and at some point in life, lower income, poorer health-care coverage, and increased physical activity involving repetitive tasks such as lifting weights or cooking with firewood. MSK pain prevalence was high. Osteoarthritis and low back pain were the most common diseases. Age, sex, physical activity, repetitive tasks, living in a rural area, and lack of health-care coverage were found to be associated with MSK pain.

Epidemiology of rheumatic diseases in Mixtec and Chontal indigenous communities in Mexico: a cross-sectional community-based study

This study aimed to estimate the prevalence of musculoskeletal (MSK) disorders and rheumatic diseases in the Chontal and Mixtec indigenous communities in the state of Oaxaca, Mexico, using the Community-Oriented Program for the Control of Rheumatic Diseases (COPCORD) methodology. After cross-culturally validating the COPCORD questionnaire for these communities, we conducted a cross-sectional, analytical, community-based census study using a house-to-house method. Positive cases of MSK disorders were assessed by primary care physicians and rheumatologists. The study population included participants aged ≥18 years from the indigenous communities of San Antonio Huitepec and San Carlos Yautepec. A total of 1061 persons participated in the study. Mean age was 46.9 years (standard deviation 19.9; age range 18–97 years); 642 (60.5 %) were women; 483 participants (45.5; 42.4–48.5 %) had MSK pain in the previous 7 days. Diagnoses were back pain 170 (16.0 %; 95 % confidence interval [CI] 13.8–18.3); osteoarthritis 157 (14.7 %; 95 % CI 12.7–17.0); rheumatic regional pain syndrome 53 (4.9 %; 95 % CI 3.7–6.4); rheumatoid arthritis 4 (0.3 %; 95 % CI 0.1–0.9); dermatomyositis 1 (0.09 %; 95 % CI 0.0–0.5); ankylosing spondylitis 1 (0.09 %; 95 % CI 0.0–0.5); systemic lupus erythematosus 1 (0.09 %; 95 % CI 0.02–0.5); and gout 1 (0.09 %; 95 % CI 0.0–0.5). 53.2 % had not received medical treatment for their disease. The prevalence of MSK disorders in indigenous communities in the Mixtec and Chontal regions is very high. The most common rheumatic diseases found were back pain and osteoarthritis. A high percentage of participants had not received medical care.

Prevalence of Hyperuricemia and Gout in Mainland China from 2000 to 2014: A Systematic Review and Meta-Analysis

We systematically identified the prevalence of hyperuricemia and gout in mainland China and provided informative data that can be used to create appropriate local public health policies. Relevant articles from 2000 to 2014 were identified by searching 5 electronic databases: PubMed, Google Scholar, Chinese Wanfang, CNKI, and Chongqing VIP. All of the calculations were performed using the Stata 11.0 and SPSS 20.0 software. The eligible articles (n = 36; 3 in English and 33 in Chinese) included 44 studies (38 regarding hyperuricemia and 6 regarding gout). The pooled prevalence of hyperuricemia and gout was 13.3% (95% CI: 11.9%, 14.6%) and 1.1% (95% CI: 0.7%, 1.5%), respectively. Although publication bias was observed, the results did not change after a trim and fill test, indicating that that impact of this bias was likely insignificant. The prevalence of hyperuricemia and gout was high in mainland China. The subgroup analysis suggested that the geographical region, whether the residents dwell in urban or rural and coastal or inland areas, the economic level, and sex may be associated with prevalence.

Rheumatoid arthritis in Latin America: the importance of an early diagnosis

The generalization of the early rheumatoid arthritis (ERA) concept and the existence of a window of therapeutic opportunity-a time span in which the institution of a proper therapeutic method for the disease would determine clinical improvement-have set the notion that early diagnosis and treatment may modify the course of the disease. Although in several regions of the world, especially in North America and Europe, since the year 2000, a significant reduction in diagnostic delay was observed in cohorts of patients with rheumatoid arthritis (RA), probably reflecting a stronger awareness of the importance of early diagnosis, this is not a reality in Latin America (LA). LA is a region of great economic inequality, with disparities in access to the public healthcare system and limited access to private medicine, being widely difficult to obtain a specialized medical evaluation in both scenarios. This paper aims to briefly review the main difficulties in the management of ERA in LA, based on the review of the literature, on the evaluation of a survey conducted among 214 rheumatologists of LA, members of Pan-American League of Associations for Rheumatology (PANLAR) and the experience of the authors. The paper also aims to propose solutions to the difficulties in managing ERA in LA.

Factors associated with treatment of osteoarthritis: Analysis of a COPCORD study in Nuevo León, México

INTRODUCTION

Osteoarthritis (OA) is the most prevalent rheumatic disease in Mexico. Treatment involves pharmacological and non-pharmacological strategies.

OBJECTIVE

To describe the factors associated with treatment of osteoarthritis in the urban and rural population of Nuevo León.

METHODS

Analysis of a cross-sectional study of patients with OA from a COPCORD study database. Univariate and multivariate analyses of the variables associated with treatment of OA.

RESULTS

We included 696 patients with OA with an average age of 58 years (SD 14.1), 484 (69.5%) women. Pain with a visual analog scale (VAS) ≥4 was present in 507 (72.8%) patients. Functional disability was present in 133 (19%) patients and a mean HAQ of 0.37 (IQR 0.75) was found. The most frequent place of OA was knee in 356 (51.1%) patients; 259 (37%) patients already knew their diagnosis. The most employed treatments were non-steroidal anti-inflammatory drugs (289 patients, 58.5%). The variables associated with treatment were age >58 years (OR 1.3, 95% CI 1.0-1.5), female gender (OR 1.17, 95% CI 1.0-1.3), VAS pain ≥4 (OR 1.3, 95% CI 1.1-1.4), functional disability (OR 2.6, 95% CI 1.6-4.1), HAQ >0.375 (OR 1.9, 95% CI 1.5-2.4), and past diagnosis of OA (OR 5.1, 95% CI 3.3-8.0). In the multivariate analysis, VAS pain ≥4 (OR 1.9, 95% CI 1.2-2.8), kneeling disability (OR 3.15, 95% CI 1.3-7.4) and previous diagnosis of OA (OR 7.6, 95% CI 4.5-12.9) had statistical significance.

CONCLUSION

factors associated with treatment of OA are VAS pain ≥4, kneeling disability and previous diagnosis of OA.

Developing Community-Based Rehabilitation Programs for Musculoskeletal Diseases in Low-Income Areas of Mexico: The Community-Based Rehabilitation for Low-Income Communities Living With Rheumatic Diseases (CONCORD) Protocol

BACKGROUND

The negative impact of musculoskeletal diseases on the physical function and quality of life of people living in developing countries is considerable. This disabling effect is even more marked in low-socioeconomic communities within developing countries. In Mexico, there is a need to create community-based rehabilitation programs for people living with musculoskeletal diseases in low-socioeconomic areas. These programs should be directed to prevent and decrease disability, accommodating the specific local culture of communities.

OBJECTIVE

The objective of this paper is to describe a research protocol designed to develop, implement, and evaluate culturally sensitive community-based rehabilitation programs aiming to decrease disability of people living with musculoskeletal diseases in two low-income Mexican communities.

METHODS

A community-based participatory research approach is proposed, including multi and transdisciplinary efforts among the community, medical anthropology, and the health sciences. The project is structured in 4 main stages: (1) situation analysis, (2) program development, (3) program implementation, and (4) program evaluation. Each stage includes the use of quantitative and qualitative methods (mixed method program).

RESULTS

So far, we obtained resources from a Mexican federal agency and completed stage one of the project at Chankom, Yucatán. We are currently receiving funding from an international agency to complete stage two at this same location. We expect that the project at Chankom will be concluded by December of 2017. On the other hand, we just started the execution of stage one at Nuevo León with funding from a Mexican federal agency. We expect to conclude the project at this site by September of 2018.

CONCLUSIONS

Using a community-based participatory research approach and a mixed method program could result in the creation of culturally sensitive community-based rehabilitation programs that promote community development and decrease the disabling effects of musculoskeletal diseases within two low-income Mexican communities.

Application of a prediction model for the progression of rheumatoid arthritis in patients with undifferentiated arthritis

INTRODUCTION

Different prediction rules have been applied to patients with undifferentiated arthritis (UA) to identify those that progress to rheumatoid arthritis (RA). The Leiden Prediction Rule (LPR) has proven useful in different UA cohorts.

OBJECTIVE

To apply the LPR to a cohort of patients with UA of northeastern Mexico.

METHODS

We included 47 patients with UA, LPR was applied at baseline. They were evaluated and then classified after one year of follow-up into two groups: those who progressed to RA (according to ACR 1987) and those who did not.

RESULTS

43% of the AI patients developed RA. In the RA group, 56% of patients obtained a score ≤ 6 and only 15% ≥ 8. 70% who did not progress to RA had a score between 6 and ≤ 8. There was no difference in median score of LPR between groups, p=0.940.

CONCLUSION

Most patients who progressed to RA scored less than 6 points in the LPR. Unlike what was observed in other cohorts, the model in our population did not allow us to predict the progression of the disease.

The prevalence of gout in an urban area of Izmir, Turkey: a population-based epidemiological study

OBJECTIVES

This study aimed to determine the prevalence of gout in a general Turkish population, according to the American College of Rheumatology (Wallace) criteria proposed for gout classification.

METHODS

This study was conducted in two districts of Izmir Province in Turkey, and involved 2835 subjects of ≥ 20 years of age. In the first stage, face-to-face interviews were performed at the subjects' registered households. In the second stage, subjects who gave positive answers in the screening questionnaire were invited to the hospital for a full examination, which included a detailed medical history, medication use and blood tests.

RESULTS

A total of 2887 subjects were contacted, and complete interviews were obtained for 2835 (1551 women, 1284 men). A total of 312 subjects (227 women, 85 men) reported experiencing a short period of joint pain accompanied by swelling, redness or reduced range of movement, and 247 (79%) of these patients underwent a detailed clinical examination in the hospital. Gout was diagnosed in 11 patients (8 men, 3 women). We found minimum age- and sex-adjusted prevalence rates of gout of 0.31% (95% CI: 0.16-0.61) in subjects of ≥ 20 years of age, and 0.72% (95% CI: 0.37-1.24) in subjects of ≥ 40 years of age.

CONCLUSIONS

Our data suggest that the estimated prevalence of gout (0.31%) is lower than the previously published estimated prevalence of rheumatoid arthritis (0.36%) in the same study population (14 definite rheumatoid arthritis cases among the 2835 subjects).

WHO-ILAR COPCORD study (stage 1, urban study) in Sanandaj, Iran

This study aims to conduct an urban Community Oriented Program for Control Of Rheumatic Diseases (COPCORD) study in Sanandaj (Kurdistan, Iran). Sanandaj with a population of 311,446 (2006 census), Caucasian of Kurdish subgroup, was selected as the field. Sanandaj was divided into 100 clusters and subjects were randomly selected from them (50 subjects from each cluster). The COPCORD study started on July 2011 and ended on June 2012. Of the households, 1,631 was visited and 5,830 persons were interviewed. The male to female ratio was 0.8-1 (44.5% males, 55.5% females). Musculoskeletal complaints during the past 7 days were detected in 42.8% of the interviewed subjects (36.3% males, 48.1% females). The distribution was 16.7% shoulder, 10% wrist, 9.7% hands and fingers, 7.7% hip, 26.3% knee, 9.9% ankle, 6.4% toes, 9.5% cervical spine, and 21.5% dorsal and lumbar spine. Degenerative joint diseases were detected in 19.4% of the subjects: 1.8% neck, 18.9% knee, 3.9% hands, and 0.51% hip. Low back pain was detected in 16.5%, sciatica in 1.2%, cervical nerve root pain in 0.24%, and soft tissue rheumatism in 5.5%. Inflammatory disorders were 0.51% rheumatoid arthritis, 0.22% seronegative spondyloarthropathy, 0.10% ankylosing spondylitis, 0.05% systemic lupus erythematosus, and 0.10% Behcet's disease . Fibromyalgia was detected in 0.62% and gout in 0.12% of the studied population. Disability was reported by 28.3%. It was present at the study time in 21.4%. Comparing the four COPCORD studies of Iran, the figures (numbers) obtained by COPCORD Sanandaj are much the same as the COPCORD study in Tehran. Joint complaints were seen less frequently than in the COPCORD urban study of Zahedan and rural study of Tuyserkan. Osteoarthritis was higher than in Tehran, but the same as the two others. Soft tissue rheumatism was rather the same. Rheumatoid arthritis was higher than Tehran and Tuyserkan, but lower than Zahedan.

A patient and physician survey of fibromyalgia across Latin America and Europe

Background

Patients and physicians from three Latin American (LA) and six European countries were surveyed in order to describe differences in journey to diagnosis, impact, and management of fibromyalgia (FM).

Methods

900 patients (300 LA; 600 Europe) and 1824 physicians (604 LA; 1220 Europe) were surveyed between October-December 2010 (LA) and February-April 2008 (Europe). Patients and physicians (GP or specialists) completed separate questionnaires, on symptoms, impact, and FM management. Interviews were conducted in local languages. Appropriate rating scales were used throughout. Data were analyzed using cross-tabulations and descriptive statistics. Significance was determined at P < 0.05 (indicated by *).

Results

In LA versus Europe, patients reported having FM symptoms for longer (100.8 vs. 83.7* months), and taking longer to be diagnosed (42.3 vs. 31.1* months). FM was characterized by multiple symptoms (11.2 vs. 6.9), but more LA patients reported 14 common symptoms*, and rated pain higher on 11-point scale (8.0 vs. 7.2*). LA patients were taking fewer medications (3.3 vs. 4.0). Patients from both regions found common symptoms very/extremely disruptive to their quality of life, but symptoms impacted daily living and ability to work more significantly in LA. Physicians (GPs or specialists) from LA more often considered problems sleeping*, difficulty concentrating*, anxiety*, depression*, numbness/tingling*, and leg cramps* very/extremely disruptive vs. European physicians. Despite headache, heightened sensitivity to touch, difficulty concentrating, and joint pain being experienced by ≥50% of patients from both regions, <15% of PCPs or specialists considered these typical FM symptoms. Patients also considered 12/14 symptoms more disruptive than PCPs or specialists in the same region. However, a higher proportion of PCPs or specialists considered FM to have a strong/very strong impact on aspects of daily living vs. patients within the same region.

Conclusions

Patient- and physician-rated disease perception and impact was often higher in LA than in Europe. Patient and physician perspective concerning FM impact and disruption were often misaligned within the same region. Our observations may be representative of cultural differences in stoicism, expression, beliefs, and attitudes to pain perception and management. Better understanding of these complexities could help targeted educational/training programs incorporating cultural differences, to improve chronic care.

National survey of knowledge, attitude and practice of fibromyalgia among rheumatologists in China

AIM

Fibromyalgia (FM) is a chronic disorder characterized by widespread musculoskeletal pain and fatigue. It is a less frequently diagnosed disease in China, thus Chinese rheumatologists may have lower awareness of FM compared with colleagues in Western countries. The aim of this study is to investigate the perceptions of FM in Chinese rheumatologists and analyze their therapeutic approach in clinical practice.

METHOD

An anonymous questionnaire survey was conducted among a nationwide sample of Chinese rheumatologists at the 15th National Rheumatology Conference in 2010. The 20-question survey included questions regarding background, work experience, perceptions of diagnosis and behaviors of treatment related to FM. Continuing medical education (CME) information was also collected in the survey.

RESULTS

Seven hundred and seven rheumatologists responded to the questionnaire, a response rate of 60%. Less than one-fifth of the respondents were experienced in dealing with FM. Although most of the respondents regarded FM as a distinct pathological entity, nearly 30% of Chinese rheumatologists believed that FM was only a psychological disorder. The respondents recognized some of the FM-related symptoms, but had limited knowledge on the diagnostic criteria. Eighty percent of the respondents declared they had difficulties in treating FM patients. However, nearly all (90.8%) respondents believed that the prognosis of FM patients was usually benign. Our data also showed that most Chinese rheumatologists were eager for CME on FM.

CONCLUSION

The awareness and perception of FM are still low among Chinese rheumatologists. CME on FM is needed for improving the quality of health care in China.

Prevalence of musculoskeletal diseases in Guatemala, Central America: the COPCORD study of 2 populations

BACKGROUND

Guatemala is a multiethnic, multilingual, and multicultural country. We have evaluated 2 different ethnic groups from (1) San Juan Sacatepéquez County (SJSC), a rural population (30% illiterate), with 65% from Kaqchiquel ethnic group; and (2) Zone 5 of Guatemala City (Z5GC), an urban population (6.6% illiterate), with 95.5% mestizos.

OBJECTIVE

This study aimed to measure simultaneously the prevalence of rheumatic diseases in these 2 Guatemalan populations, both located in the State of Guatemala.

METHODS

A convenience sample of 4000 inhabitants 15 years and older was selected in each group. The Core Community Oriented Program for Control of Rheumatic Diseases Questionnaire was used in this survey. Phase 1 was for screening (identification of study subjects), phase 2 was for obtaining information from subjects with musculoskeletal complaints, and phase 3 was for rheumatologic diagnostic purposes. Phases 1 and 2 were performed by 6 interviewers. Phase 3 was completed by 4 rheumatologists.

RESULTS

In phase I, 8000 subjects were identified in both groups. In phase II, 949 subjects reported musculoskeletal complaints: 371 (39%) in Z5GC and 578 (61%) in SJSC. In phase III, 419 patients were clinically evaluated: 141 (34%) in Z5GC and 278 (66%) in SJSC. The most prevalent musculoskeletal diseases were (1) osteoarthritis, (2) soft tissue rheumatism, (3) rheumatoid arthritis, (4) low back pain, and (5) arthralgias of unknown etiology. Osteoarthritis and soft tissue rheumatism were significantly more common in the rural population.

CONCLUSIONS

The most prevalent musculoskeletal diseases in Guatemala seem to be similar to those in most previous Community Oriented Program for Control of Rheumatic Diseases studies. Most subjects were still working. Further studies examining medical care received and impact on function can now be of interest.