Burden of Musculoskeletal (MSK) Pain and Arthritis in India: A Community Oriented Program for Control of Rheumatic Diseases (COPCORD-Bone and Joint Decade (BJD)) India Project.

BACKGROUND

Several countries have participated in WHO COPCORD. The Global Disease Burden program (GBD) reports selected MSK disorders. We used a COPCORD India protocol to estimate the national burden of MSK disorders.

MATERIALS AND METHODS

Trained paramedics used standard questionnaires to screen the population and identify respondents with current and/or past MSK pain (non-traumatic) in 12 survey sites (8 rural); cross-sectional design and prospective data. Several standard measures were recorded; MSK pain was self-reported (on human manikin). The site rheumatologist examined each respondent and provided a clinical diagnosis. Pooled data (anonymized) from all sites was analyzed using standard statistical software. Standardized point prevalence rates (adjusted to Indian Census) and odds ratios (risk factors) were calculated: 95% confidence intervals in parentheses.

RESULTS

56 548 population (60% rural, response rate > 70%) was screened; 10 273 respondents (18%, 65% women). The prevalence of MSK pain was 16.14 (14.2, 18.3) and higher in the rural population (20% vs. 10.3%); rheumatoid arthritis 0.34%, undifferentiated inflammatory arthritis 0.22%, spondyloarthritis 0.23%, osteoarthritis 4.39%, Gout 0.05%, chikungunya arthritis 1.2%. Non-specific arthralgias, soft tissue pains, and degenerative arthritis were dominant disorders; 12% of respondents reported inflammatory arthritis. Significant risk factors associated with MSK pain included female gender, poor literacy, non-vegetarian diet, chronic non-MSK illness, past trauma, and tobacco use. Limitations included non-random selection, clinical diagnosis, and limited investigations. However, in comparison to GBD, the COPCORD outcome seemed all-inclusive and clinically meaningful.

CONCLUSION

The high prevalence of MSK pain and arthritis indicates a huge disease burden in India and prioritizes the need for a national control program.