Background Though the autoimmune rheumatic diseases are gaining due attention the true burden of soft tissue rheumatism (STR) and low back pain (LBP) in rural population in India remains poorly studied. We hypothesised that such conditions are very common and therefore would require increased resource allocation at the community level.
Objectives In this prospective study we estimated the prevalence of STR and LBP pain in a rural community of southern state of Kerala, India using the WHO-ILAR-COPCORD (Community Oriented Program for the Control of Rheumatic Diseases) methodology.
Methods Randomly chosen rural community was both administratively and geographically well defined situated in the Mallapuram District consisting of 1,392 households.
House to house survey was conducted (phase I) and one randomly chosen individual >15years of age in each visited home was interviewed. All positive-COPCORD (pain in the last 7 days, without traumatic event) individuals were evaluated by trained family practitioners to record pain and community perceptions (Phase II) and then by a rheumatologist (Phase III) if needed and appropriate diagnostic classification were assigned. Particular care was taken to determine past Chikungunya virus (CHIKV) infection based on typical narration of the fever, review of clinical records and serology (IgM).
Results 1,032 community residents were surveyed. The mean age was 39.05±16.47 years; age range, 15 to 99 years), 544 (52.7%) of subjects were women. Literacy was high (95%) and 905 individuals (88%) had completed secondary education or above. Only 93 individuals (0.8%) were unemployed and but a majority (798, 77.32%) belonged to poor socio-economic category (ie class III, IV or V).
261 individuals (25.29%, 95% CI 42.1-48.2%) had MSK pain in the last 7 days. Of these, 120 (11.63%, 95% CI 9.67- 13.59%) associated pain to a traumatic event. Therefore the prevalence of rheumatic musculoskeletal disorders (RMSD) was 13.66%, 95% CI 11.56-15.76% (141 individuals). 34% of the affected individuals were in the age group of 55-64 years with a rising prevalence with increasing age and a majority 99 (70%) of all affected individuals (n=141) were female. As expected osteoarthritis 64 (6.20%; 95% CI 5.23-7.17) was the commonest RMSD, LBP 27 (2.62%, 95% CI 2.68-3.56) and STR 25 (2.42%, 95% CI 2.04-2.80) were the second and third most common diagnoses. The STR could be categorised into a wide range of conditions whereas all LBP were non inflammatory. In no individual evidence for past CHIKV infection was confirmed.
Conclusions In the studied rural Indian community the prevalence of STR and LBP was significant underlining the need for education and awareness regarding these conditions, proper management and developing viable support systems for the affected individuals. Unlike some other parts of India this community did not have outbreaks of Chikungunya virus infections therefore we believe that these prevalence estimates are truly representative of common STRs and LBP at the community level. These results can easily be extrapolated to other south east Asian countries and also underscores the importance of such COPCORD surveys in assessing the real burden of MSK pain as it can be measured only at the community level, and rheumatology clinics and tertiary care setups are likely to capture only the tip of an iceberg.
Disclosure of Interest None declared