Spectrum of rheumatological disorders: an experience of 337 cases in a tertiary care hospital in Pokhara valley, Nepal

Abstract

AbstractAim: To reveal the commonly occurring important types of rheumatological disorders, as well as various clinico‐epidemiological aspects, concurrent medical illnesses, and the ancillary medications used, along with their side‐effects.Method: A total of 365 patients with various rheumatological disorders were studied at the Rheumatology Department of Manipal Teaching Hospital, Pokhara, Nepal from September 2001 to September 2004. The diagnosis was based on the criteria of the American College of Rheumatology (1988). A pro forma was prepared for 30 common rheumatological disorders, listing patient identification, clinical characteristics, disease duration, objective and subjective assessment of the progress of the diseases, monitoring the response of treatment and side‐effects of medications. Patients aged 15–75 years, men and women suffering from various musculoskeletal disorders, fulfilling the ACR criteria, were studied. Each patient was followed up at 1–3 monthly interval and data recorded systematically to monitor the progress of joint function and evaluating the effects of medications.Results: Out of the 365 patients recorded, only 337 fulfilled the criteria laid down by ACR. Most common rheumatological disorders in order of frequency were soft tissue rheumatism (40.0%), inflammatory arthritis (21.36%) and bone and cartilage diseases (21.06%). Connective tissue disorders were only 4.74%. Seronegative spondyloarthritis group was only 2.67% and least common disease was gout at 3.85%. Rheumatoid arthritis was the most common inflammatory arthritis observed in 20.17% of total cases. Fibromyalgia was the most common soft tissue rheumatism seen in 19.88%. Osteoarthritis of knee, hand and hip were the most common degenerative disorder of the bone and cartilage, constituting 10.38%. Lumbago, lumbar spondylolisthesis and spinal canal stenosis together comprised 14.24% of patients with low back pain. Cervical spondylosis and all types of shoulder joint pain syndromes comprised 5.93% and 5.34%, respectively. Patients were mostly in the age group 20–60 years. The most common type of drug used in all rheumatic conditions was non‐steroidal anti‐inflammatory drugs in 81.6% of cases followed by steroids in 26.7%, disease‐modifying and cytotoxic drugs in 18.6% and 17.2% of cases, respectively. Chronic obstructive airway disease and hypertension constituted the major concurrent illness in 23.63% and 18.78%, respectively.Conclusion: This unique type of clinico‐epidemiological study on rheumatological disorders, the first in Nepal, will provide a rich database for future investigations into rheumatology and would plan for all levels of prevention and therapy in the future.