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• W1975676640 abstract "Are rheumatic diseases the same in the Western and the Eastern world? This is a major question for physicians because the majority of textbooks come from the Western world and all the figures and statistics and the clinical picture of diseases are those seen in the Western world. It is therefore important to know if they are applicable to the Eastern world. The first step is to know how they are distributed in the APLAR region (Asia and Pacific area). COPCORD (Community Oriented Program for Control of Rheumatic Diseases) was created by the collaboration of World Health Organization (WHO) and the International League of Associations for Rheumatology (ILAR) in 1983. The aim of the program was the recognition, prevention, and the control of Rheumatic diseases in developing countries, where two-thirds of the world's population live. The program was designed to work with small monetary and material resources. It had three stages: 1 – prevalence of rheumatic disorders and identification of risk factors; 2 – education of primary health care physicians, paramedical professionals, and the community; 3 – improved health care, and environmental aetiologic research of rheumatic diseases. Sixteen countries have performed the program, among them 12 countries from the APLAR region (Fig. 1). The latest study was done in Iran and was finished in September 2005. These countries are Australia,1 Bangladesh,2 China,3–5 Indonesia,6 India,7 Iran,8,9 Kuwait,10 Malaysia,11 Pakistan,12 Philippines,13–15 Thailand16 and Vietnam.17 COPCORD in APLAR countries. Stage 1 was designed to evaluate at least 1500 adult people (over 15 years of age). Many of the participating countries, depending on their resources, performed the program on higher numbers. The largest number of evaluated people in a single population was the Iran study with 10 000 participants. Data from Iran are not all compiled and the results presented here are preliminary results on 7000 participants. The number of participants in the Australian study was 1437. There was another study in Aboriginals on 847 persons. The Bangladeshi study was on 5211 people, in China (Shanghai study) on 2010, the China (Shanghai 1998 study) on 6584, in China (Beijing study) on 4192, in China (Shantou study) on 5057, and in China (Chenghai study) on 2040. The Indonesian urban study was on 1071 individuals and the Indonesian rural study on 4683, the Indian study on 4092, the Iranian study on 10 000, the Kuwaiti study on 7670, the Malaysian study on 2594, the Pakistani study on 2090, the Philippine rural study on 846 and the urban study on 3006, the Thai study on 2463, and the Vietnamese study on 2119 people (Fig. 2). Number of people interviewed. The prevalence of rheumatic complaints (Fig. 3) varied largely from one country to another. In Australia it was 34%, in Australian Aboriginals 33% (only patients with pain during the last week), Bangladesh 26.3%, China (Shanghai) 24.3%, China (Shanghai 1998) 13.3%, China (Beijing) 40.3%, China (Shantou) 9.7%, China (Chenghai) 18.1%, Indonesia (urban) 31.3%, Indonesia (rural) 23.6%, India 18.2% (last week only complaint), Iran (urban) 52.4% and rural 54.3%, Kuwait 26.8%, Malaysia 21.1% (last week only complaint), Pakistan 14.8% (last week only complaint), Philippines (rural) 21.4%, Philippines (urban) 16.3%, Thailand 36.2%, and Vietnam 14.9%. There is a large difference between the Northern part of China (Beijing) with 40.3% and the Southern part (Shantou) with 9.7%. It is also interesting to notice that in Pakistan, India, and Philippines (urban), the prevalence is under 20% as it is for Shantou and Shanghai in China. Rheumatic complaints. Low back pain is one of the major reasons people consult rheumatologists. In China (Beijing study) 35% complained of having low back pain. This is one-third of the adult population over 15 years of age. Beijing is in the northern part of China. The next highest number is Indonesia, the urban study with 23% and then Australia (urban study) with 22%. Then comes Iran (urban study) with 21% followed by Iran (rural study) with 19%. China (Shanghai study) is 16%, Indonesia (rural) 15%, China (Shantou) 13%, Malaysia and Bangladesh 12% and Australia (Aboriginal) 12%, India and Vietnam and Philippines (rural) 11%, Chenghai 10% and Thailand 4%, and Pakistan as low as 2%. Looking at the Chinese study the large difference between north and south is again striking. Neck pain is a less frequent complaint. The highest number was in Australia (urban study) with 17%, followed by Iran (urban) 14%, and Indonesia (urban) 12%. The other figures are all much lower, under 10%. It was 7% for Indonesia (rural study), 6% for Iran (rural), 6% Malaysia, 6% India, 5% China (Beijing), 5% Indonesia (rural), 4% China (Chenghai), 3.5% China (Shanghai), 2% China (Shanghai), and 2% China (Shantou). This time there was not much difference between different Chinese studies. Knee pain is one of the most important and frequent complaints in rheumatology. It was very high in China (Beijing) with 30%. This was followed by Iran (urban study) 26%, Iran rural (18%), Vietnam 18%, Australia (urban) 15%, India 13%, Australia (Aboriginal) 11%, China (Shanghai) 11%, China (Shanghai) 7%, Philippines (rural) 7%, China (Chenghai) 6.5%, Thailand 6%, and China (Shantou) 3%. Looking back at the China studies, there is again a huge difference between the Beijing study (30%) and the Shantou study (3%). Complaint of hip pain is rare in Asia. Apart from Iran with 7.5% (urban) and Iran 2% (rural), the other figures are under 1%. It was 0.8% in Shanghai, 0.2% in the Philippines (rural study) and as low as 0.08% in Thailand. Shoulder pain is more often reported. In Iran (urban study) it was 15%, followed by Australia (urban) 10%, Australia (Aboriginal) 9%, India 7%, China (Beijing, Shanghai, Shantou) 5%, China (Chenghai) 2%, and Thailand just 1%. Elbow pain was seen in 7% in Iran (urban), 6.5% in India, 6% Australia (urban), 4% China (Beijing), 3% Indonesia (rural), 2% China (Chenghai), 2% Thailand, 1% China (Shantou), 1% China (Shanghai), and 0.5% China (Shanghai). We don't have much data about hand pain. It was reported in 10% from Iran (urban study), 9% from China (Shanghai), 6% from India, 2% from China (Shanghai), and as low as 0.6% from Thailand. Ankle pain was reported by 10% in Iran (urban study), 6.5% in India, 0.8% in Thailand, 0.8% in China (Shanghai), 0.6% in China (Shanghai), and 0.5% in Philippines (rural). Osteoarthritis is one of the most important and frequently encountered diseases in the rheumatology field. The prevalence is high in Iran (rural study) at 16%. The figure is 15% in Iran (urban study), 13% in China (Shanghai), 11% in Thailand, 9% in Bangladesh, 8% in Australia (urban), 6% in India, 5.5% in Australia (Aboriginal), 4% in Philippines (urban), 4% in Vietnam, and 4% in Pakistan. Most osteoarthritis is of the knee joint. Hip osteoarthritis is rare in Asia. Soft tissue rheumatism is seen with high frequency in Vietnam, around 15%. In other countries it is reported in less than 10%. It is 7% for Australia (Aboriginals), 6% Iran (rural), 6% Australia (urban), 5.5% India, 5% Iran (urban), 4% Philippines (urban), 3.5% China (Shanghai), 3% China (Shanghai 1998), 3% Bangladesh, 2% Pakistan, and 1.5% Thailand. Fibromyalgia was rarely reported and with a low prevalence rate. The highest was reported from Bangladesh with 4%. Then it was from Pakistan 2%, Iran (rural) 1%, Iran (urban) 0.5%, and Philippines (urban) 0.2%. Rheumatoid arthritis did not reach the classic 1% prevalence in any of the APLAR countries. The highest prevalence reported was from Australia (rural) with 0.7%. Next was Pakistan with 0.55% and India with 0.5%. Then were China (Shanghai 1998) 0.47%, Iran (urban) 0.37%, China (Beijing) 0.34%, Iran (rural) 0.32%, China (Shantou) 0.32%, Indonesia (urban) 0.3%, Vietnam 0.28%, Indonesia (rural) 0.2%, Philippines (rural) 0.2%, China (Shanghai) 0.2%, Philippines (urban) 0.17%, Malaysia 0.15%, and Thailand 0.12%. Seronegative spondylarthropathies were seen in 0.5% of Australians (Aboriginal), 0.34% of Iranians (urban), 0.26% of Chinese (Beijing), 0.26% of Chinese (Shantou), and 0.21% of Australians (urban study). The prevalence was 0.12% in Malaysia and Thailand, 0.11% in China (Shanghai 1998), 0.10% in Pakistan, 0.08% in Iran (rural), and 0.03% in Philippines (urban study). Connective tissue diseases were seen rarely in Asia. It was seen at 0.1% in Iran (urban study), 0.09% in Vietnam, 0.08 in Thailand, 0.06 in China (Shanghai), 0.05 in Pakistan, 0.02% in China (Shantou), and 0.01 in China (Beijing). Gout is known to be quite frequent in South-east Asia. It was seen in 4% of the population in Australia in the Aboriginal study and in 1.5% in the urban study. In Indonesia it was 0.8%, in the Philippines in 0.6%, in Iran (rural) 0.3%, in China (Shanghai 1998) in 0.3%, in China (Shanghai) in 0.2%, in Thailand in 0.2%, in Vietnam and Pakistan in 0.14%, in Philippines (urban) 0.13%, in India 0.12%, and in Iran (urban study) in 0.10%. It is interesting to note that gout is five times more frequent in the rural study from the Philippines than in the urban study. The same difference exists for the Iran study, but gout is only three times more frequent in the rural study. This may be explained by the genetic background of the studied population. In rural areas (in villages) people have a greater possibility of being from the same family or related families than in big cities. The mean prevalence of rheumatic diseases in APLAR countries was calculated by the mean results of individual countries after adjustment for the number of samples from each country. Rheumatic complaints were seen in 26.3% of the adult population over the age of 15 years. Low back pain was reported by 13.8%, neck pain by 6.2%, knee pain by 14.2%, hip pain by 3%, shoulder pain by 6.7%, ankle pain by 4.6%, elbow pain by 3.7%, wrist pain by 5.2%, and hand pain by 5.6%. Osteoarthritis was detected in 9.6%, soft tissue rheumatism in 4.7%, fibromyalgia in 1.5%, rheumatoid arthritis in 0.33%, seronegative spondylarthropathy in 0.19%, connective tissue diseases in 0.06%, and gout in 0.38%. Prevalence of rheumatic diseases in Asia was estimated by the results of individual countries after adjustment for population total of each country. Rheumatic complaints were seen in 21.4% of the adult population over the age of 15 years. Low back pain was reported by 15.9%, neck pain by 4.7%, knee pain by 12.3%, hip pain by 0.85%, shoulder pain by 5.7%, ankle pain by 3.3%, elbow pain by 4%, wrist pain by 3.4%, and hand pain by 5.5%. Osteoarthritis was detected in 9.3%, soft tissue rheumatism in 4.4%, fibromyalgia in 2.1%, rheumatoid arthritis in 0.38%, seronegative spondylarthropathy in 0.2%, connective tissue diseases in 0.08%, and gout in 0.22% of the general population. Although there are multiple differences between different studies, the overall estimation of rheumatic diseases in APLAR countries is 1/5 in adults (over the age 15). Osteoarthritis is at twice the level of soft tissue rheumatism. Fibromyalgia is quite rare. Rheumatoid arthritis is one-third of what is classically estimated in the Western countries. Gouty arthritis is as frequent as rheumatoid arthritis. Although the COPCORD questionnaire is standard, the way it was applied differed in different studies. In some studies, it was self-applied if the interviewed person was literate. In some others, the questionnaire was applied by a trained interviewer to all subjects. In some studies, subjects needing a physical examination were examined the same day and in others with some delay (up to several weeks). The results therefore are not all obtained within a strict methodology. A standardized method for each step for the COPCORD project is warranted for future studies." @default.
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• W1975676640 title "Rheumatic diseases in the APLAR region" @default.
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