The prevalence of musculoskeletal complaints in a rural area in Iran: a WHO-ILAR COPCORD study (stage 1, rural study) in Iran

The objective of this study is to study the prevalence of musculoskeletal complaints and disorders in a rural area in Iran. Interviews were conducted in randomly selected subjects from five villages in Tuyserkan County, northwestern part of Iran. The three phases of stage 1 Community Oriented Program for Control of Rheumatic Diseases were done during the same day. A total of 614 houses was visited, 1,565 persons interviewed, and 1,192 persons examined. Musculoskeletal complaints during the past 7 days were detected in 66.6% (shoulder 22.7%, wrist 17.4%, hands and fingers 14.9%, hip 13.9%, knee 39.2%, ankle 19.6%, toes 12.7%, cervical spine 17.9%, and dorsolumbar spine 41.9%). Degenerative joint diseases were detected in 20.5% (cervical spondylosis 2.2%, knee osteoarthritis [OA] 19.3%, hand OA 2.7%, and hip OA 0.13). Low back pain was detected in 23.4%, soft tissue rheumatism in 2.2%, rheumatoid arthritis in 0.19%, ankylosing spondylitis in 1.1%, systemic lupus erythematosus in 0.06%, and fibromyalgia in 0.06%. The prevalence of rheumatic complaints in rural Iran is very high and needs attention in the curricula of medical schools and in the planning of rural health care by the government.     

Effect of ethnic origin (Caucasians versus Turks) on the prevalence of rheumatic diseases: a WHO-ILAR COPCORD urban study in Iran

The objective of this study was to compare the prevalence of musculoskeletal complaints and rheumatic disorders in Caucasians and Turks in an identical environment. Subjects were selected randomly for an interview from Tehran’s 22 districts. The Community Oriented Program for Control of Rheumatic Diseases questionnaire was filled in, positive cases were examined, and if needed, laboratory or X-ray tests were performed. A total of 4,096 houses were visited, and 10,291 persons were interviewed. They were 71.4% Caucasians and 23.1% Turks with similar distribution of age and gender. Musculoskeletal complaints of the past 7 days were detected in 40.8% of Caucasians and 45.5% of Turks (p?<?0.001). In Caucasians, the total of musculoskeletal complaints in men was 33.8% (95% CI, 31.4–36.2%) versus 48.3% in women (95% CI, 45.7–50.8%). In Turks, the total of musculoskeletal complaints in men was 36.6% (95% CI, 32.2–41.1%) versus 55.8% in women (95% CI, 55.8–60.6%). The data of Caucasians versus Turks were as follows: knee pain 20.2% (95% CI, 18.2–22.1) versus 24.1% (95% CI, 20.5–27.6), with p?<?0.001; dorso-lumbar spine pain 15.1% (95% CI, 13.6–16.6) versus 18.4% (95% CI, 15.1–21.8), with p?<?0.001; shoulder pain 10.7% (95% CI, 9.4–11.9) versus 12.3% (95% CI, 9.7–14.8), with p?=?0.025; osteoarthritis 14.1% (95% CI, 12.8–15.2) versus 16.4% (95% CI, 14.3–18.6), p?=?0.04; and knee osteoarthritis 12.3% (95% CI, 11.8–14.1) versus 15.3% (95% CI, 13.3–17.4), with p?<?0.001). There were no significant differences regarding the prevalence of soft tissue rheumatism, rheumatoid arthritis, ankylosing spondylitis, Behcet’s disease, fibromyalgia, and gout. Although musculoskeletal complaints were more frequent in Turks than in Caucasians, the prevalence of rheumatic disorders was rather similar except for knee osteoarthritis.     

Prevalence of the rheumatic diseases in urban Vietnam: a WHO-ILAR COPCORD study

OBJECTIVE: To determine the prevalence rates of musculoskeletal disorders in an urban Vietnamese population. METHODS: The Community Oriented Program for Control of Rheumatic Disease (COPCORD) Stage I study was carried out in 16 groups in the Trung Liet Commune, Dong Da District, Hanoi City, Vietnam. Phase 1: the WHO ILAR COPCORD Core Questionnaire was applied by primary health care workers to 2119 urban subjects aged 16 years and over. Phase 2: 276 positive responders who had musculoskeletal complaints were interviewed by nurses and examined one week later. Phase 3: 261 positive responders in phase II were examined by 3 rheumatologists and 38% of these subjects required radiographic and blood tests to classify rheumatic disease categories. RESULTS: The response rates were 94.4%, 86.2%, and 94.6% in phases 1, 2, and 3, respectively. The prevalence of musculoskeletal pain was 14.9%. The most common musculoskeletal complaints were knee pain 18.2%, low back pain 11.2%, and soft tissue disorder 15.4%. Functional disability was reported in 6.04% of the survey population. The prevalence of rheumatic diseases was OA 4.1%, rheumatoid arthritis 0.28%, osteoporosis 0.47%, connective tissue disease 0.09%, and gout 0.14%. CONCLUSION: The prevalence of musculoskeletal pain in 2119 adults in an urban population in Vietnam was 14.5%, and osteoarthritis was the most commonly found arthritis.     

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.     

Risk factors associated with rheumatic complaints: a WHO-ILAR COPCORD study in Shantou, Southeast China

OBJECTIVE: To validate the differences of the prevalence of rheumatic symptoms between the north and south part of China and to investigate the associated risk factors for rheumatic complaints in Shantou, China. METHODS: Four samples together comprising 10,638 people > or = 16 years of age were surveyed in 1987, 1992, 1995, and 1999. The protocol of the ILAR-China Collaborative Study or the WHO-ILAR COPCORD Core Questionnaire was implemented. Data on rheumatic symptoms that were part of these surveys were collected and analyzed. RESULTS: The prevalence rate of rheumatic complaints was increasing in the Shantou area during the recent decade (in 1987 11.6%, 1992 12.5%, 1995 16.0%, and 1999 19.8%). However, it was still lower than the rate in Beijing, China, in 1987 (40.0%). Rheumatic symptoms were more prevalent in women than in men, and were more frequently seen in the elderly than in young people. The most frequently involved site was the low back followed by the knee and neck. Lumbar pain was more frequent among rural residents, while neck pain was more prevalent in the urban school-age population group. The prevalence of knee pain was significantly higher in people living in multi-story buildings without elevators compared with those living in single-story houses. The peak value of bone mineral density (BMD) in the Shantou population was 0.839 +/- 0.085 g/cm2 in men, and 0.723 +/- 0.064 g/cm2 in women, significantly higher than that reported in 13 other provinces and cities of China including Beijing. The sense of seeking a physician's care was higher in the population with a higher prevalence of rheumatic symptoms than that in the group with a lower prevalence of complaints. However, no significant difference was found in the rate of disability among the different population samples. CONCLUSION: The prevalence rate of rheumatic complaints was lower in Shantou than in Beijing. Socioeconomic status, environmental differences (e.g., Shantou in the southern and Beijing in the northern part of China), sex, age, occupation, ergonomics, BMD, and awareness of seeking medical care might all be risk factors associated with the prevalence of rheumatic complaints.     

Prevalence of musculoskeletal complaints in urban communities in multi-ethnic Suriname: a cross-sectional study with the COPCORD methodology (stage 1, phase 1 and 2)

Clinical Rheumatology - Musculoskeletal complaints (MSCs) are a major burden worldwide. In Suriname, a South American developing country, the epidemiology of MSCs and its related disorders is still...     

Prevalence of Behcet's disease in Iran: a WHO‐ILAR COPCORD stage I study

Aim: To elucidate the prevalence of Behcet's disease (BD) during the World Health Organization‐International League of Associations for Rheumatology Community Oriented Program for Control of Rheumatic Disease study in Iran. The old estimate was 16 per 100,000 inhabitants, but this was just an estimation and a more precise figure was required. Materials and methods: Tehran, the capital of Iran with 1/10th of Iran's population, was selected as the field for the COPCORD study. The population of Iran is of mixed ethnicity (Caucasians 75.4%, Turks 22%, and Semites 2.6%). The same distribution was found in Tehran's general population. Tehran has 22 districts; 50 clusters were randomly selected from them. Interviewers passed an exam by interviewing 20 subjects. The observed agreement was 0.96. The chance expected agreement was 0.531325. The kappa coefficient was 0.919 (standard error: 0.112). The z‐score was 8.19. The one tailed P‐value was < 0.0001. Rheumatologists were selected from the ‘Rheumatology Subspecialty’, that is, those who were scheduled to become a rheumatology professor in one of Iran's medical schools. Results: The response rate was 75%. From 10,291 subjects interviewed all subjects with positive questionnaires were examined; seven had definitive BD and five probable BD. The prevalence was calculated on the seven definitive cases. It was 68 for 100,000 inhabitants. The confidence interval was 33.5–137. Four patients were female and three were male. All had oral and genital aphthosis, four had ocular lesions, three had pseudo‐folliculitis, and one had joint manifestations. Conclusions: The prevalence of BD in Iran is 68 per 100,000 inhabitants, which is the second highest prevalence after Turkey (80–370) in the world, and far behind comes Saudi Arabia with 20, China 14, and Japan 13.4 per 100,000 inhabitants.     

Correction to: Prevalence of musculoskeletal complaints in urban communities in multi-ethnic Suriname: a cross-sectional study with the COPCORD methodology (stage 1, phase 1 and 2)

Clinical Rheumatology - The footnote of Fig. 2 in the published original version of the above article went missing and the correct figure is presented in this article.]     

Rheumatic disease in an Australian Aboriginal community in North Queensland, Australia. A WHO-ILAR COPCORD survey

OBJECTIVE: To estimate prevalences of rheumatic diseases in Aboriginal Australians. METHODS: The methodology of the Community Oriented Program for the Control of Rheumatic Diseases (COPCORD) was followed. Everyone aged 15 years or older in Yarrabah, North Queensland, was invited to complete a COPCORD Core Questionnaire. Aboriginal health workers carried out a house-to-house survey during January 2002. People reporting current musculoskeletal symptoms and 56 others (controls) were examined at the community health center. RESULTS: Eighty percent of the target population was covered during the survey. Eight hundred and forty-seven questionnaires were completed (47% men) and 135 people refused, a response of 86%. Rheumatic symptoms within the previous 7 days were reported by 33% and past symptoms by 22%. The most common sites of current pain were low back (12.5%), knee (11.2%), and shoulder (8.9%). Sixty-seven people (7.7%) said activities were limited by their symptoms. Two hundred and sixty-three people were examined, and the most common diagnoses were soft tissue pain (point prevalence 7.4%), osteoarthritis (5.5%), and low back pain (4.3%). The cumulative prevalence of gout was 7.0% in men and 0.9% in women over the age of 15 years. The relative risk of gout associated with drinking regularly was 2.5, and with body mass index > 25 was 3.3. No rheumatoid arthritis or systemic lupus erythematosus cases were identified, but there were 4 cases of psoriatic arthritis (point prevalence 0.5%). CONCLUSION: This is the first unselected population study of rheumatic diseases in Australian Aboriginals. There was a high prevalence of gout among men, with modifiable factors of weight and alcohol identified.     

Excellent endpoints from step-down bridge combination therapy of 5 immunosuppressants in NSAID-refractory ankylosing spondylitis: 6 year international study in Asia - WHO-ILAR COPCORD stage II treatment of the autoimmune diseases

OBJECTIVE: To achieve induction and maintenance of remission in ankylosing spondylitis (AS) refractory to nonsteroidal antiinflammatory drugs with "step-down bridge combination" of 5 immunosuppressants, as an alternative to costly biologic DMARD. Primary endpoints were the percentage of patients achieving ASAS 20 at the end of Year 6; secondary endpoints were patients achieving ASAS 50 and ASAS 70, induction and maintenance of clinical and radiological remission, and the side effects of this combination of immunosuppressive drugs. METHODS: In a 6-year uncontrolled international open-label prospective study, 54 men and 25 women with AS were enrolled after exclusion criteria were applied. Included patients were treated with individualized combinations of low-dose intravenous methylprednisolone + cyclophosphamide + methotrexate (for the first 6 mo). When erythrocyte sedimentation rate dropped to < or = 20 mm (men < or = 10 mm), low-dose oral mycophenolate mofetil and cyclosporine were prescribed for at least 2 years. Assessments were executed at baseline, Weeks 1 and 2; Months 1, 2, 4, and 6; and Years 1, 2, 4, and 6. RESULTS: After 15/79 dropouts were accounted for, 64/79 patients achieved ASAS 20, ASAS 50, and ASAS 70. Disease remission occurred in 60/79 at 6 months when IV drugs were tapered. Gastrointestinal side effects were observed in 20/79 patients; no liver, renal, cardiovascular, and hematologic adverse effects were observed. CONCLUSION: Step-down bridge combination of 5 immunosuppressants achieved ASAS 20, ASAS 50, and ASAS 70 in 64/79 patients, and remission in 60/79 patients with NSAID-refractory AS. Controlled studies are needed to confirm this method, and to study the role of these different drugs in developing countries in Asia, where the majority of patients with NSAID-refractory AS are unable to obtain treatment with tumor necrosis factor-alpha blockers.     

Prevalence of asthma and rhinitis in bakery workers in the city of Sanandaj, Iran

Baker's asthma is one of the most common forms of occupational asthma. This study was conducted to determine prevalence of asthma and rhinitis among bakery workers in the city of Sanandaj, the provincial center of Kurdistan province in the west of Iran in the in Summer 2006. In this study 776 bread bakery workers were included. These subjects were selected randomly among 1620 bakery workers. The diagnosis of asthma was based on a medical history of episodic symptoms of cough, chest tightness, and dyspnea and spirometry. Airflow obstruction was determined with spirometry, the definition of airflow obstruction which was used in this study was an FEV1/FVC ratio < 0.8, and FEV1 or FVC increases of > or = 12 percent and at least 200 mL after using a short-acting inhaled beta2-agonist. Rhinitis was diagnosed by typical history of work related symptoms. Analyses were performed on 776 subjects (all were men) without missing data for asthma and rhinitis. All of subjects were male with mean age of 33.69+/-11.09 years. Mean duration of bakery working for these subjects was 13.91+/-9.37 years. Prevalence of asthma at the time of study was 11.9%. 93 subjects were diagnosed as asthma with history, physical and spirometry findings. 31 (33.3%) of asthmatic workers were diagnosed as asthma previously and 62 (66.6%) workers were known as new asthmatic patients which were diagnosed in this study program. The prevalence of rhinitis was (9.9%). Subjects with asthma had longer history of working at bakery than others (P=0.001). Asthma prevalence among these bakery workers that were included in our study was similar and in some instances the prevalence was lower than other studies.     

Heavy metals in selected edible vegetables and estimation of their daily intake in Sanandaj, Iran

The levels of four different heavy metals [cadmium (Cd), lead (Pb), chromium (Cr) and copper (Cu)] were determined in various vegetables [leek (Allium ampeloprasum), sweet basil (Ocimum basilicum), parsley (Petroselinum crispum), garden cress (Lepidium sativum) and tarragon (Artemisia dracunculus)] cultivated around Sanandaj City. The contributions of the vegetables to the daily intake of heavy metals from vegetables were investigated. One hundred samples (20 samples per month) were collected for five months. Atomic absorption spectrometry was used to determine the concentrations of these metals in the vegetables. The average concentrations of each heavy metal regardless of the kind of vegetable for Pb, Cu, Cr and Cd were 13.60 +/- 2.27, 11.50 +/- 2.16, 7.90 +/- 1.05 and 0.31 +/- 0.17 mg/kg, respectively. Based on the above concentrations and the information of National Nutrition and Food Research Institute of Iran, the dietary intake of Pb, Cu, Cr and Cd through vegetable consumption was estimated at 2.96, 2.50, 1.72 and 0.07 mg/day, respectively. It is concluded that the vegetables grown in this region are a health hazard for human consumption.     

Epidemiology of rheumatic diseases in rural and urban populations in Indonesia: a World Health Organisation International League Against Rheumatism COPCORD study, stage I, phase 2.

To determine the incidence of musculoskeletal pain, disabilities, and help seeking behaviour, a questionnaire was administered to a rural population of 2184 men and 2499 women and an urban population of 481 men and 590 women aged over 15 years by house to house interviews with completion rates of 95.2% (rural) and 97.1% (urban). The incidences of pain in the joints, back, or neck were 23.6% (rural) and 31.3% (urban). The incidence of disability due to an inability to walk, lift, carry, and dress was 2.8% (rural) and 0.9% (urban). The percentage of the population with pain who had to stop work owing to disability was 75% (rural) and 78% (urban). Official health care facilities were used by 62% (rural) and 71% (urban) of the population. Traditional health care was used by 87% (rural) and 89% (urban). The high percentage of subjects unable to work was due to a predominance of manual labour occupations (rural, 90%, urban, 80%). The age and sex specific incidence of rheumatic diseases in these populations were similar to other developing and developed countries. The primary rheumatology service was inadequate due to the low priority given by the health service to non-communicable diseases and inadequate rheumatology teaching of the primary health care doctors during undergraduate training. Musculoskeletal pain is a major public health problem in Indonesia and is still not fully appreciated.