Rheumatic Musculoskeletal Disorders Research Articles

Treatment of rheumatic musculoskeletal disorders.

Non-medicinal therapies with water, salts, exercise, massage, supportive devices, and electricity have been used for centuries and continue to be of benefit for some people with musculoskeletal disorders. Historical texts refer to the two electuaries mithridatium and theriaca as early therapeutic attempts of man to provide relief of musculoskeletal symptoms and attempt disease cures. For over 200years, morphine-derived products have been used for musculoskeletal pain. The development of acetyl salicylic acid was a major breakthrough in joint pain management. This was followed by the introduction of nonsteroidal anti-inflammatory agents, paracetamol, and the use of corticosteroids. The gold-based compounds were the initial disease-modifying drugs and have been followed by the highly successful biologics agents. The basic objectives of musculoskeletal pain management include: reduction or elimination of joint pain; improvement or restoration of joint function and mobility; improvement of muscle strength to protect cartilage, ligaments, and joint capsule; prevention and reduction of damage to joint cartilage and supporting structures.

Frequency and severity of sarcopenia in patients with inflammatory and noninflammatory musculoskeletal diseases : Results of a monocentric study in a tertiary care center

Sarcopenia (SP) is defined as the pathological loss of muscle mass and function. This is aclinically relevant problem, especially in geriatric patients, because SP is associated with falls, frailty, loss of function, and increased mortality. People with inflammatory and degenerative rheumatic musculoskeletal disorders (RMD) are also at risk for developing SP; however, there is little research on the prevalence of this health disorder in this patient group using currently available SP criteria. To investigate the prevalence and severity of SP in patients with RMD. A total of 141consecutive patients over 65years of age with rheumatoid arthritis (RA), spondylarthritis (SpA), vasculitis, and noninflammatory musculoskeletal diseases were recruited in across-sectional study at a tertiary care center. The European Working Group on Sarcopenia in Older People (EWGSOP1 and2) definitions of presarcopenia, SP, and severe SP were used to determine the prevalence. Lean mass as aparameter of muscle mass and bone density were measured by dual X‑ray absorptiometry (DXA). Handgrip strength and the short physical performance battery (SPPB) were performed in astandardized manner. Furthermore, the frequency of falls and the presence of frailty were determined. Student'sT-test and the χ2-test were used for statistics. Of the patients included 73% were female, the mean age was73 years and 80% had an inflammatory RMD. According to EWGSOP2, 58.9% of participants probable had SP due to low muscle function. When muscle mass was added for confirmation, the prevalence of SP was 10.6%, 5.6% of whom had severe SP. The prevalence was numerically but not statistically different between inflammatory (11.5%) and noninflammatory RMD (7.1%). The prevalence of SP was highest in patients with RA (9.5%) and vasculitis (24%), and lowest in SpA (4%). Both osteoporosis (40% vs. 18.5%) and falls (15% vs. 8.6%) occurred more frequently in patients with SP than those without SP. This study showed arelatively high prevalence of SP, especially in patients with RA and vasculitis. In patients at risk, measures to detect SP should routinely be performed in astandardized manner in the clinical practice. The high frequency of muscle function deficits in this study population supports the importance of measuring muscle mass in addition to bone density with DXA to confirm SP.

Physical activity assessment with wearable devices in rheumatic diseases: a systematic review and meta-analysis.

In the management of rheumatic musculoskeletal disorders (RMDs), regular physical activity (PA) is an important recognized non-pharmacological intervention. This systematic review and meta-analysis aims to evaluate how the use of wearable devices (WDs) impacts physical activity in patients with noninflammatory and inflammatory rheumatic diseases. A comprehensive search of articles was performed in PubMed, Embase, CINAHL and Scopus. A random-effect meta-analysis was carried out on the number of steps and moderate-vigorous physical activity (MVPA). Univariable meta-regression models were computed to assess the possibility that the study characteristics may act as modifiers on the final meta-analysis estimate. In the analysis, 51 articles were included, with a total of 7488 participants. Twenty-two studies considered MVPA outcome alone, 16 studies considered the number of steps alone, and 13 studies reported information on both outcomes. The recommended PA threshold was reached for MVPA (36.35, 95% CI 29.39, 43.31) but not for daily steps (-1092.60, -1640.42 to -544.77). Studies on patients with fibromyalgia report a higher number (6290, 5198.65-7381.62) of daily steps compared with other RMDs. Patients affected by chronic inflammatory arthropathies seemed to fare better in terms of daily steps than the other categories. Patients of younger age reported a higher overall level of PA than elderly individuals for both the number of steps and MVPA. Physical activity can be lower than the recommended threshold in patients with RMDs when objectively measured using WD. WDs could be a useful and affordable instrument for daily monitoring physical activity in RMDs and may support an increase in activity levels. CRD42021227681, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=227681.

Safety of Biologic-DMARDs in Rheumatic Musculoskeletal Disorders: A Population-Based Study over the First Two Waves of COVID-19 Outbreak

This study aims to explore disease patterns of coronavirus disease (COVID-19) in patients with rheumatic musculoskeletal disorders (RMD) treated with immunosuppressive drugs in comparison with the general population. The observational study considered a cohort of RMD patients treated with biologic drugs or small molecules from September 2019 to November 2020 in the province of Udine, Italy. Data include the assessment of both pandemic waves until the start of the vaccination, between February 2020 and April 2020 (first), and between September 2020 and November 2020 (second). COVID-19 prevalence in 1051 patients was 3.5% without significant differences compared to the general population, and the course of infection was generally benign with 2.6% mortality. A small percentage of COVID-19 positive subjects were treated with low doses of steroids (8%). The most used treatments were represented by anti-TNF agents (65%) and anti-IL17/23 agents (16%). More than two-thirds of patients reported fever, while gastro-intestinal symptoms were recorded in 27% of patients and this clinical involvement was associated with longer swab positivity. The prevalence of COVID-19 in RMD patients has been confirmed as low in both waves. The benign course of COVID-19 in our patients may be linked to the very low number of chronic corticosteroids used and the possible protective effect of anti-TNF agents, which were the main class of biologics herein employed. Gastro-intestinal symptoms might be a predictor of viral persistence in immunosuppressed patients. This finding could be useful to identify earlier COVID-19 carriers with uncommon symptoms, eventually eligible for antiviral drugs.

AB1227 PREVALENCE OF RHEUMATIC MUSCULOSKELETAL DISORDERS IN A RURAL AREA OF UPPER EGYPT: WHO-ILAR COPCORD BASED COMMUNITY STUDY

Background:Rheumatic musculoskeletal disorders (RMSDs) are a common cause of long term pain and physical disability. In developed countries, RMSDS are a major cause of absence from work and thus have a big financial burden on the country economic status. Several studies have been published the incidence and prevalence of RMSDs in different world countries and found to be widely variable. Estimation of the extend of the problem of RMSDs in developing world, especially in rural economies will help better understanding of the risk factors that contribute to the initiation and progression of these diseases and help the health care authorities to provide proper health program services in these areas to reduce the physical and financial burden of RMSDs (Bagher et al., 2011; Majumdar et al., 2015 and Usenbo, et al., 2015).Objectives:To estimate the prevalence rate of RMSDs in a rural population in Upper Egypt.Methods:A cross-sectional based study was carried out and included 3988 subjects of population (2013 females and 1975 males). Mean age of patients was (46.89±15.25ys). They proceeded 4 phases of World Health Organization/International League of Associations for Rheumatology community-oriented program for control of rheumatic diseases survey questionnaire WHO-ILAR Community Oriented Program for screening of rheumatic diseases. Modified Health Assessment Questionnaire (HAQ) was used to assess the disability severity. Individuals suspected to have any rheumatic diseases were subjected to full clinical examination, laboratory and radiological investigations to reach a final diagnosis. They were classified according to appropriate criteria of diagnosis of diseases.Results:A prevalence rate of RMSDs was 16.22%, more prevalence in females (10.38% vs. 5.84% for males, P=0.000). The mean age of patients with RRMSDSs were older (46.89±15.25 yrs) than healthy individuals (29.56±18.95 yrs) (P=0.0001) and with increasing age (≥45-≤ 55 yrs).The identified RMSDs were OA (8.5%), Soft tissue rheumatism (STR) (6.57%), spinal disorders (SD) (6.47%), fibromyalgia (FM) (0.60%), RA (0.30%), arthralgia (0.18%), SPAs (0.15%), Gout(0.6%), Pseudogout (0.08%), SLE (0.5%), JIA(0.03) and MCTD (0.03%). The prevalence rates for the majority of RRMSDSs were higher in females and with increasing age. About two thirds of the patients had grade II disability.Conclusion:The prevalence rate of RMSDs in a rural population ≥15years in Upper Egypt has been estimated to be 16.22%.The most prevalent RMSDs are OA, STR and SD causing the greatest burden of the disease. The predictive risk of RMSDs has to be assessed in future studies.

Effect of Dysmetabolisms and Comorbidities on the Efficacy and Safety of Biological Therapy in Chronic Inflammatory Joint Diseases.

In the present study we evaluated how systemic arterial hypertension (SAH), dyslipidemia and diabetes mellitus influence the efficacy, safety and retention rate of biological disease-modifying anti-rheumatic drug (bDMARD) treatment in rheumatic musculoskeletal disorders (RMDs). The charts of RMD patients treated with the first-line bDMARD were reviewed, collecting data on safety, efficacy and comorbidities at prescription (baseline, BL), after 6 months (6M) and at last observation on bDMARD (last observation time, LoT). In 383 RMD patients, a higher rate of adverse events at 6M (p = 0.0402) and at LoT (p = 0.0462) was present in dyslipidemic patients. Patients who developed dyslipidemia or SAH during bDMARD treatment had similar results (dyslipidemia p = 0.0007; SAH p = 0.0319) with a longer bDMARD retention as well (dyslipidemia p < 0.0001; SAH p < 0.0001). SAH patients on angiotensin converting enzyme inhibitors (ACEis) or angiotensin-II receptor blockers (ARBs) continued bDMARDs for longer than non-exposed patients (p = 0.001), with higher frequency of drug interruption for long-standing remission rather than inefficacy or adverse reactions (p = 0.0258). Similarly, dyslipidemic patients on statins had a better bDMARD retention than not-exposed patients (p = 0.0420). In conclusion, SAH and dyslipidemia may be associated with higher frequency of adverse events but a better drug retention of first-line bDMARD in RMDs, suggesting an additional effect of ACEis/ARBs or statins on the inflammatory process and supporting their use in RMD bDMARD patients with SAH/dyslipidemia.

Prevalence of chronic chikungunya and associated risks factors in the French West Indies (La Martinique):A prospective cohort study.

BackgroundThe chikungunya virus (CHIKV) is a re-emerging alphavirus that can cause chronic and potentially incapacitating rheumatic musculoskeletal disorders known as chronic chikungunya arthritis (CCA). We conducted a prospective cohort study of CHIKV-infected subjects during the 2013 chikungunya outbreak in Martinique. The aim of this study was to assess the prevalence of CCA at 12 months and to search for acute phase factors significantly associated with chronicity.Methodology/Principal findingsA total of 193 patients who tested positive for CHIKV RNA via qRT-PCR underwent clinical investigations in the acute phase (<21 days), and then 3, 6, and 12 months after inclusion. The Asian lineage was identified as the circulating genotype. A total of 167 participants were classified as either with or without CCA, and were analyzed using logistic regression models. The overall prevalence of CCA at 12 months was 52.1% (95%CI: 44.5–59.7). In univariate analysis, age (RD 9.62, 95% CI, 4.87;14.38, p<0.0001), female sex (RD 15.5, 95% CI, 1.03;30.0, p = 0.04), headache (RD 15.42, 95% CI, 0.65;30.18 p = 0.04), vertigo (RD 15.33, 95% CI, 1.47;29.19, p = 0.03), vomiting (RD 12.89, 95% CI, 1.54;24.24, p = 0.03), dyspnea (RD 13.53, 95% CI, 0.73;26.33, p = 0.04), intravenous rehydration (RD -16.12, 95% CI, -31.58; -0.66 p = 0.04) and urea (RD 0.66, 95% CI, 0.12;1.20, p = 0.02) were significantly associated with the development of CCA. For the subpopulation with data on joint involvement in the acute phase, the risk factors significantly associated with CCA were at least one 1 enthesitis (RD 16.7, 95%CI, 2.8; 30.7, p = 0.02) and at least one tenosynovitis (RD 16.8, 95% CI, 1.4–32.2, p = 0.04).ConclusionsThis cohort study conducted in Martinique confirms that CCA is a common complication of acute chikungunya disease. Our analysis emphasized the importance of age and female sex for CCA occurrence, and highlighted the aggravating role of dehydration during the acute phase. Early and adequate hydration were found to reduce the risk chronic chikungunya disorders.Trial registrationclinicaltrials.gov (NCT01099852).

P37 Exploring the experience of pain flares in adolescent inflammatory and non-inflammatory musculoskeletal disorders: a phenomenological study

Abstract Background Adolescents with inflammatory and non-inflammatory rheumatic musculoskeletal disorders (RMD) experience acute exacerbations in pain, referred to as pain flares in the adult literature. But little remains known about what pain flares are, why they occur, how they are managed and what lasting effects they have during adolescence. This study explored the lived experience of pain flares in adolescents with RMD. Methods Adolescents with juvenile idiopathic arthritis (JIA) or chronic idiopathic pain syndromes (CIPS) were recruited from a UK tertiary paediatric and adolescent rheumatology centre. Data were collected using semi-structured interviews and visual aids, and analysed using interpretative phenomenological analysis. Results Participants were eight females and two males aged between 13 and 17 years (M = 14.7, SD = 1.25). Four participants had JIA and six had CIPS. All participants experienced periods when pain deviates from their usual variation in pain, but none reported using the term pain flare to describe these experiences. These experiences were conceptualised as a journey of change from their 1) daily life with pain, 2) pre-flare period, 3) flare period, to their 4) post-flare period. 1) In daily life, adolescents report a level of pain that is usual for them which they manage and continue their daily routines around. 2) Pain, at times, increased beyond usual levels and adolescents reported noticing when a pain flare was coming on (e.g. due to physical exertion). They employed strategies for managing the pre-flare period, however, if they did not succeed in preventing a flare, or when flares occurred without a trigger or controllable cause, pain began to intrude on their lives. 3) All pain flares were described as an increase in the intensity of their usual pain, and were also associated with an increase in the location, duration and/or quality of pain; an increase in other unpleasant symptoms such as fatigue, psychological symptoms, headaches and/or sickness; and a reduction in physical, emotional, cognitive and/or social functioning. The frequency of flares was variable, ranging from weekly flare events to less than two a year. Flares were generally short lived, lasting a few hours to a few days. The majority of flares were managed with parental input, with adolescents seeking medical support when a flare was perceived to be associated with infection in JIA. 4) As flares were brought under control, the pain returned to usual levels but the psychological symptoms outstayed the pain. Participants took actions to regain the level of normality experienced in daily life. Conclusion Participants had varying interpretations of what constitutes a flare, but the key finding was that flares are not only an increase in pain intensity, but other features are also required to change. These findings help to differentiate flares from normal variation in pain. Conflicts of Interest The authors declare no conflicts of interest.

Prevalence and risk factors of post chikungunya rheumatic musculoskeletal disorders: a prospective follow-up study in French Guiana.

The estimated seroprevalence in the general population after chikungunya virus (CHIKV) epidemics ranged from 38 to 63%. Despite a low case fatality, subacute and chronic rheumatic forms of CHIKV infection generate significant morbidity and have a socioeconomic impact. The objective of the study was to estimate the prevalence of chronic post-CHIKV rheumatic or musculoskeletal pain (pCHIK-RMSP) at 3 and 6months after the initial symptoms. An observational study was conducted at Cayenne General Hospital in French Guiana between April 1 and June 30, 2014. All patients seen for CHIKV infection confirmed by RT-PCR were prospectively included. Pregnant women and children under 15 were excluded from the study. All patients were called by phone at 3 and 6months to enquire about the presence of pCHIK-RMSP. Out of a total of 254 eligible patients, 168 were selected. The mean age was 45.3years (SD ± 1.4yo) and the sex ratio (M/F) was 0.75. No death was reported. At 3months, 40.2% (95% CI 31.1-49.3) of patients (n = 45/112) had pCHIK-RMSP and 31.3% (95% CI 22.2-40.4) of patients (n = 31/99) at 6months. The median time of end to pain was 2weeks after the date of onset of signs. The present study provides succinct but informative data about pCHIK-RMSP, which represents the real burden of the disease. There are few studies on that subject in the Amazonian region, but our study shows a lower impact than in the Indian Ocean islands where the population is older.

Clinical spectrum of post-chikungunya rheumatic musculoskeletal disorders and use of disease-modifying antirheumatic drugs to treat the chronic inflammatory entities: 6-year experience from Reunion Island

Aim The re-emerging invalidating chikungunya (CHIK) disease has recently extended to temperate areas. Following the acute febrile polyarthritis, miscellaneous long-lasting rheumatic musculoskeletal disorders (RMSKD) are reported, consistent with chronic inflammatory rheumatisms (CIR) notably rheumatoid arthritis (RA). The post CHIK-infection stage remains a challenge to treat, while the early use of disease-modifying antirheumatic drugs (DMARDs) is recommended in RA. After the 2005-2006 CHIK outbreak in Reunion Island, we retrospectively categorized CHIKrelated RSMKD and analyzed the empirical use of DMARDs starting with methotrexate (MTX) to treat the CIR forms.

Prevalence and factors related to rheumatic musculoskeletal disorders in rural south India: WHO-ILAR-COPCORD-BJD India Calicut study

To assess the prevalence and factors related to rheumatic musculoskeletal disorders (RMSD) in a rural population of south India. The cross-sectional study included all individuals, 15years and above, in a rural unit of Calicut District in North Kerala. Data were collected using the validated World Health Organization - International League of Associations for Rheumatology - Community Oriented Program for the Control of Rheumatic Diseases - Bhigwan model questionnaire by trained volunteers. In Phase 1 details of demographic characteristics, major co-morbidities and perceived musculoskeletal aches and pains were elicited. Phases 2 and 3 further evaluated and diagnosed the subjects. Predictors for RMSD were assessed using binary logistic regression analysis. There were 4999 individuals in the study. The prevalence of RMSD was 24.9% (95% CI 23.73; 26.12%). Females constituted 50.7% of the population; 5.1% of the respondents were illiterate; 80.9% belonged to low-income groups. Diabetes mellitus and hypertension affected 4.1% and 5.4% of the subjects respectively. The predictors for RMSD in the population were female sex, age, illiteracy, married status, low-income group, vegetarian diet, current alcohol consumption, current tobacco use, history of injury or accidents, diabetes and hypertension. Symptom-related ill-defined rheumatism (10.39%) followed by osteoarthritis (3.85%) were the most prevalent in the Phase 3 rheumatological evaluation. There is an urgent need to introduce lifestyle modifications in high-risk groups and start rehabilitation for those affected. Community rheumatology in primary health care settings in rural areas needs to be strengthened by introducing national programs addressing RMSD at the grassroots level.

Rheumatic‐musculoskeletal manifestations in type 2 diabetes mellitus patients in south India

To determine the prevalence of rheumatic musculoskeletal disorders (RMSD) in type 2 diabetes mellitus (T2DM) and study their risk factors. Diagnosed patients of T2DM attending the diabetic clinic in a premier teaching institution in south India were interviewed and requested to mark their RMS pain sites on a mannequin and intensity of pain on a visual analogue scale (VAS). A complete RMS examination was done and diagnoses were noted. These RMSDs were compared with those in age- and sex-matched, non-diabetic individuals from the general population. Association of RMSD with variables was determined using Chi-square test and multiple logistic regression models for risk factors were created using SPSS 17.0 software. Prevalence of RMSD in 310 cases and controls was 42.58%; 95% CI: 37.08-48.08 and 31.61%; 95% CI: 26.43-36.79, respectively. RMS pain was marked by 194 individuals. Knee was the most common site of pain (33.4%). Prevalence of common RMSD was osteoarthritis knee (20.64%; 95% CI 16.14-25.16), frozen shoulder (16.45%; 95% CI: 12.32-20.58), diffuse idiopathic skeletal hyperostosis (14.52%; 95% CI: 10.6-18.44) and limited joint mobility (8.06%; 95% CI: 5.03-11.09). Age (P = 0.046), duration of T2DM (P < 0.001) and glycosylated hemoglobin (P < 0.001) were found to have significant associations with RMSD. In logistic regression analysis, duration (OR: 1.467; 95% CI: 1.210-1.779) and severity (OR: 1.354; 95% CI: 1.169-1.569) of T2DM were identified as the risk factors. Thorough RMS examination should be included as an integral part of care in T2DM patients.

Is There an Urban-Rural Divide? Population Surveys of Rheumatic Musculoskeletal Disorders in the Pune Region of India Using the COPCORD Bhigwan Model

To estimate urban prevalence of rheumatic musculoskeletal (MSK) disorders and compare to an earlier rural regional study. We screened 8145 adults from a preselected urban locality in Pune, India, for MSK pain in a cross-sectional house-to-house survey (Stage I) over 20 weeks. The World Health Organization-International League of Associations for Rheumatology (WHO-ILAR) Community Oriented Program for Control of Rheumatic Diseases (COPCORD) Bhigwan model was used. Thirty trained community volunteers completed Phases I and II questionnaires, concurrent with rheumatology evaluation (Phase III). Clinical diagnosis was based on standard diagnosis/classification criteria. Point prevalence rates from our survey and the earlier Bhigwan village (Pune district) survey were standardized (adjusted age-sex to India population census 2001) and are reported for osteoarthritis (OA), rheumatoid arthritis (RA), seronegative spondyloarthritis (SSA), and inflammatory arthritis (IA). One thousand one hundred fifty-two urban cases (65% women) were identified (14.1%, 95% confidence interval 13.4, 14.9). The self-reported pain sites (Phase II) were hip (0.4), knees (6.3), ankle (1.9), feet (0.7), shoulders (2), hands (1.3), wrist (1.2), neck (1.9), upper back (1.7), low back (5.5), thigh (1.5), calf (1.4), and sole (0.8); corresponding rural sites being hip (1.1), knees (13.7), ankle (7), feet (1.6), shoulders (7.9), hands (6.3), wrist (6.9), neck (6.8), upper back (8.4), low back (12.6), thigh (4.8), calf (7.1) and sole (2.2). OA disorders, soft tissue rheumatism (STR) and ill-defined aches and pains were predominant in both surveys; < 10% reported IA. The major disorders among urban cases were OA (4), STR (1.2), RA (0.2, ACR criteria 1988), undifferentiated IA (0.3), SSA (0.3), and gout (0.06); corresponding rates in Bhigwan were OA (6.3), STR (3.8), RA (0.5), undifferentiated IA (0.8), SSA (0.3), and gout (0.1). Infections were conspicuously absent. While similar in spectrum, standardized prevalence rates of self-reported pain sites and rheumatic MSK disorders were significantly lower in the urban (current Pune COPCORD surveys) versus rural (Bhigwan) community, and in both communities aches and pains that are poorly understood by modern science were predominant.

O42 Standardized prevalence of rheumatic musculoskeletal disorders (MSK) in population based surveys in the Pune region using the WHO ILAR COPCORD Bhigwan model: is there an urban rural divide?

O42 Standardized prevalence of rheumatic musculoskeletal disorders (MSK) in population based surveys in the Pune region using the WHO ILAR COPCORD Bhigwan model: is there an urban rural divide?

Comparison Between Two NSAIDs (Non selective &amp; selective COX-2 Inhibitor) According to their Renal Toxicity on Elderly People

The nonsteroidal anti-inflammatory drugs (NSAIDs) are widly used all over the world for different rheumatic musculoskeletal disorders. Like any other chemical compounds, they have different side effects like renal toxicity that becomes very serious when used for long time especially from elderly people whose already have a reduced renal function or those This with renal or cardiac problems that may increase the incidence of such toxicity.&#x0D; study focusing on this point, by comparing between 2 NSAIDs, a non selective-COX inhibitor (Indomethacin) and selective COX-2 inhibitor (Meloxicam) according to their renal toxicity on elderly patients, depending on changes in values of blood urea nitrogen (BUN), serum creatinine (S. Cr.) &amp; serum potassium (S. K+) concentrations as parameters of such toxicity. In another way we investigate whether the renal or cardiac problems will increase such toxicity of NSAIDs on elderly patients or not.The study involved 80 elderly patients, healthy and with renal or cardiac problems, selected from rheumatologic outpatient clinic and given one of the 2 NSAIDs as adrug of choice for their present complaints for a period of 15 days.It was clearly appeared from results, that both NSAIDs couse similar extent of renal side effects and the presence of renal and/or cardiac problems could increase the susceptibility of such toxicity especially renal impairment &amp; renal hypertension.

The WHO–ILAR COPCORD Bhigwan (India) model: foundation for a future COPCORD design and data repository

Launched by the International League of Associations for Rheumatology (ILAR) and the World Health Organization (WHO), the Community oriented program for control of rheumatic diseases (COPCORD) aims to fill the gaps in the knowledge on the global burden of rheumatic musculoskeletal disorders (RMS). During the population survey (Stage I), data on symptoms (pain and disability in focus), rather than diseases or syndromes, is collected. The survey may be followed by a planned stage to impart health education, identify risk factors, and devise preventive and control strategies. Several countries in the Asia Pacific and Pan-America have completed COPCORD survey. Africa has recently joined. Only COPCORD Bhigwan (India) has continued into the tenth year. COPCORD Bhigwan is a fast-track model that has provided significant data on rheumatic disorders. Using COPCORD Bhigwan model, the Bone and Joint Decade (BJD) India has launched several population surveys to measure the RMS burden. There is an urgent need for a COPCORD data repository. Several COPCORD have differed in their methods. Differences pertain to population sample size, techniques for data collection and recording, chronology of events and phases, and classification of symptoms/diseases/disorders. The COPCORD model in current global use needs to be revised. Based on the COPCORD Bhigwan model, a future design for COPCORD is proposed. COPCORD needs to have a uniform and standardized core program with a flexibility to cater to regional needs. It must imbibe some of the recent advances in rheumatology while retaining its socioeconomic appeal. It must have a planned follow-up/longitudinal observational phase. Above all, it must serve and benefit community. WHO-ILAR COPCORD and the global BJD initiative must join hands to serve a common cause of controlling rheumatic musculoskeletal disorders. COPCORD is also a reflection of the ILAR mission statement "think global, act local."