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Epidemiology and socioeconomic impact of the rheumatic diseases on indigenous people: an invisible syndemic public health problem
  1. Ingris Peláez-Ballestas1,
  2. Ysabel Granados2,
  3. Rosana Quintana3,
  4. Adalberto Loyola-Sánchez4,
  5. Flor Julián-Santiago5,
  6. Celenia Rosillo2,
  7. Alfonso Gastelum-Strozzi6,
  8. Jose Alvarez-Nemegyei7,
  9. Natalia Santana8,
  10. Adriana Silvestre9,
  11. Cesar Pacheco-Tena10,
  12. Mario Goñi11,
  13. Conrado García-García1,
  14. Ligia Cedeño2,
  15. Bernardo A Pons-Éstel12
  16. on behalf of the Latin American Study Group of Rheumatic Diseases in Indigenous Peoples (GLADERPO)
  1. 1 Rheumatology Unit, Hospital General de México ‘Dr Eduardo Liceaga’, Mexico City, Mexico
  2. 2 Rheumatology Department, Hospital ‘Dr Manuel Nuñez Tovar’ Maturín, Maturín, Venezuela
  3. 3 Rheumatology Department, Hospital Provincial de Rosario, Rosario, Santa Fe, Argentina
  4. 4 Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada
  5. 5 Graduate School, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
  6. 6 Research Unit, ICAT-UNAM, Mexico City, Mexico
  7. 7 Research Unit, Regional High Specialty Hospital, Mérida, Yucatán, Mexico
  8. 8 Rheumatology Department, IMSS, Chihuahua, Mexico
  9. 9 Community Department, Health Ministry, Rosario, Santa Fe, Argentina
  10. 10 Faculty of Medicine, Autonomous University of Chihuahua, Chihuahua, Mexico
  11. 11 Instituto de Reumatología, Ortopedia y Fisiatría (IROF), Santa Fe, Argentina
  12. 12 Rheumatology Department, Regional Center for Autoimmune and Rheumatic Diseases (Centro Regional de Enfermedades Autoinmunes y Reumaticas, CREAR), Rosario, Santa Fe, Argentina
  1. Correspondence to Dr Ingris Peláez-Ballestas, Rheumatology Unit, Hospital General de México ‘Dr Eduardo Liceaga’, Mexico City, Mexico; pelaezin{at}


Epidemiological studies in Latin America suggest indigenous people lack proper healthcare for musculoskeletal (MSK) and rheumatic diseases.

Objectives This study aimed to estimate the prevalence of MSK disorders and rheumatic diseases in eight Latin American indigenous communities, and to identify which factors influence such prevalence using network analysis and syndemic approach.

Methods This is a cross-sectional, community-based census study according to Community-Oriented Program for the Control of Rheumatic Diseases methodology. Individuals with MSK pain, stiffness or swelling in the past and/or during the last 7 days were evaluated by participating physicians. A descriptive, univariable and multivariable analysis was performed, followed by a network analysis.

Results We surveyed 6155 indigenous individuals with a mean age of 41.2 years (SD 17.6; range 18–105); 3757 (61.0%) were women. Point prevalence in rank order was: low back pain in 821 (13.3%); osteoarthritis in 598 (9.7%); rheumatic regional pain syndromes in 368 (5.9%); rheumatoid arthritis in 85 (1.3%); undifferentiated arthritis in 13 (0.2%); and spondyloarthritis in 12 (0.1%). There were marked variations in the prevalence of each rheumatic disease among the communities. Multivariate models and network analysis revealed a complex relationship between rheumatic diseases, comorbidities and socioeconomic conditions.

Conclusions The overall prevalence of MSK disorders in Latin American indigenous communities was 34.5%. Although low back pain and osteoarthritis were the most prevalent rheumatic diseases, wide variations according to population groups occurred. The relationship between rheumatic diseases, comorbidities and socioeconomic conditions allows taking a syndemic approach to the study.

  • rheumatic diseases
  • indigenous population
  • epidemiology
  • syndemic approach
  • network analysis

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  • IP-B, YG and BAP-É contributed equally.

  • Handling editor Josef S Smolen

  • Contributors IPB, YG and BAPE participated in the conception, design, data acquisition, analysis and drafting of the manuscript. RQ, ALS, FJS, CR, JAN, NS, AS, CPT, MG, CGG and LC participated in data acquisition and drafting of the manuscript. AGS participated in the analysis and drafting of the manuscript. All authors read and approved the final version of the manuscript.

  • Funding National Council for Science and Technology (CONACYT)–Salud 2011-01-162154. BAPE’s work was supported by the Federico Wilhelm Agricola Foundation.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The study protocol was approved by the indigenous community boards and institutional ethics committees.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data are available but must be requested from the researchers representing the GLADERPO Group (IPB and BAPE) through a specific application request for the use of data, which will be evaluated by the GLADERPO Group.

  • Collaborators Argentina; Rosana Quintana, Adriana M.R. Silvestre, Mario Goñi, Nora Mathern, Romina Nieto, Vanina García María Cecilia Barrios, Julio Miljevic, Cristina Pirgione,Marisa Jorfen , Bernardo A. Pons-Estel. España; Marta Alarcón Riquelme .México; Ingris Peláez Ballestas, Flor Julián Santiago, José Alvarez Nemegyei Adalberto Loyola Sánchez, María Victoria Goycochea, Conrado Garcia Natalia Santana César Pacheco J.F. Matamoros Sanin, Gabriela Cruz, Hazel Garcia Morales ,Arturo Velasco Gutierrez, Susana A. González, Celia M. Quiñonez, Danyella Del Río, José Francisco Moctezuma, Everardo Alvarez, Janitzia Vazquez-Mellado. Venezuela;Ysabel granados, Ivan Steckman, Rosa Chacón, Yanira Martínez, Gloris Sánchez , Celenia Rosillo, Ligia Cedeño, Sol Berbin. Latin American Study Group of Rheumatic Diseases in Indigenous Peoples (GLADERPO).