COPCORD

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Australia

1. Muirden KD, Valkenburg HA, Hopper J, Guest C. The epidemiology of Rheumatic diseases in Australia. APLAR Rheumatology. Eds. Nasution AR, Darmawan J. Churchil Livingstone Tokyo. 1992:409-210.

2.
Nicola Minaur, Steven Sawyers, Jonathan Parker, John Darmawan. Rheumatic Disease in an Australian Aboriginal Community in North Queensland, Australia. A WHO-ILAR COPCORD Survey. J Rheumatol. 2004 May;31(5):965-72.
Minaur N, Sawyers S, Parker J, Darmawan J. Rheumatic disease in an Australian Aboriginal community in North Queensland, Australia. A WHO-ILAR COPCORD survey. J Rheumatol. 2004 May; 31(5):965-72.
OBJECTIVE: To estimate prevalences of rheumatic diseases in Aboriginal Australians. METHODS: The methodology of the Community Oriented Program for the Control of Rheumatic Diseases (COPCORD) was followed. Everyone aged 15 years or older in Yarrabah, North Queensland, was invited to complete a COPCORD Core Questionnaire. Aboriginal health workers carried out a house-to-house survey during January 2002. People reporting current musculoskeletal symptoms and 56 others (controls) were examined at the community health center. RESULTS: Eighty percent of the target population was covered during the survey. Eight hundred and forty-seven questionnaires were completed (47% men) and 135 people refused, a response of 86%. Rheumatic symptoms within the previous 7 days were reported by 33% and past symptoms by 22%. The most common sites of current pain were low back (12.5%), knee (11.2%), and shoulder (8.9%). Sixty-seven people (7.7%) said activities were limited by their symptoms. Two hundred and sixty-three people were examined, and the most common diagnoses were soft tissue pain (point prevalence 7.4%), osteoarthritis (5.5%), and low back pain (4.3%). The cumulative prevalence of gout was 7.0% in men and 0.9% in women over the age of 15 years. The relative risk of gout associated with drinking regularly was 2.5, and with body mass index > 25 was 3.3. No rheumatoid arthritis or systemic lupus erythematosus cases were identified, but there were 4 cases of psoriatic arthritis (point prevalence 0.5%). CONCLUSION: This is the first unselected population study of rheumatic diseases in Australian Aboriginals. There was a high prevalence of gout among men, with modifiable factors of weight and alcohol identified.

Bangladesh

1. Haq SA, Das BB, Rahman F, Chowdhury MAJ, Alam MN, Islam N, Chowdhury MR, Mahmud TAK. Prevalence of rheumatic disorders in a Bangladeshi urban community: COPCORD study. Abstracts. 10th Asia Pacific League of Associations for Rheumatology Congress. Bangkok, Thailand, December 1 – 6, 2002, p 182.

2. Haq SA. COPCORD Bangladesh. APLAR 2004 Proceeding Book. The 11th Asia Pacific League of Associations for Rheumatology Congress. Korea, Jeju, September 11—15, 2004, pp 85-6.

3. Haq SA. A Bangladeshi RA patient treated with Darmawan protocol. The 11th Asia Pacific League of Associations for Rheumatology Congress. Korea, Jeju, September 11—15, 2004, pp 308-9.

4. Zahiruddin M, Das BB, Banik S, Haq SA, Saha A, Chowdhury MAJ, Rahman MF, I MN, Alm MN. Prevalence of knee osteoarthritis in adult population in a rural area of Bangladesh: a community based study. Journal of Medicine 2004; 5: 69-73.

5. Haq SA, Darmawan J, Islam MN, Uddin MZ, Das BB, Rahman F, Chowdhury MA, Alam MN, Mahmud TA, Chowdhury MR, Tahir M. Prevalence of Rheumatic Diseases and Associated Outcomes in Rural and Urban Communities in Bangladesh: A COPCORD Study. J Rheumatol. 2005 Feb; 32 (2):348-53.
Haq SA, Darmawan J, Islam MN, Uddin MZ, Das BB, Rahman F, Chowdhury MA, Alam MN, Mahmud TA, Chowdhury MR, Tahir M. Prevalence of rheumatic diseases and associated outcomes in rural and urban communities in Bangladesh: a COPCORD study. J Rheumatol. 2005 Feb;32(2):348-53.
OBJECTIVE: To estimate the burden of rheumatic disorders in adults (age >/= 15 yrs) in Bangladeshi rural and urban communities. METHODS: The survey was carried out in a rural community, an urban slum, and an affluent urban community with samples of 2635, 1317, and 1259 adults, respectively. Through door-to-door surveys, trained interviewers identified subjects with musculoskeletal pain. A socio-culturally adapted and validated Bengali version of the COPCORD (Community Oriented Program for Control of Rheumatic Disorders) questionnaire was used. Trained internists and rheumatologists examined the positive respondents using an English COPCORD examination sheet to identify respondents with definite rheumatic disorders and to reach a diagnosis. RESULTS: The overall point prevalence of musculoskeleletal pain was 26.3%. The point prevalence estimates of musculoskeletal pain in rural, urban slum, and affluent urban communities were 26.2% (women 31.3%, men 21.1%), 24.9% (women 27.5%, men 22.6%), and 27.9% (women 35.5%, men 18.6%), respectively. Most commonly affected sites were low back, knees, hips, and shoulders in all 3 communities. The point prevalence of definite rheumatic disorders was 24.0%. The commonest rheumatic disorders were osteoarthritis of the knees, nonspecific low back pain, lumbar spondylosis, fibromyalgia, and soft tissue rheumatism. Their prevalence estimates were 7.5%, 6.6%, 5.0%, 4.4%, and 2.7%, respectively, in the rural, 9.2%, 9.9%, 2.0%, 3.2%, and 2.5%, respectively, in the urban slum, and 10.6%, 9.2%, 2.3%, 3.3%, and 3.3% in the urban affluent community. The point prevalence of functional disability was 25.5%, 23.3%, and 24.8%, respectively, in the rural, urban slum, and urban affluent communities. Among the positive respondents, 22%, 52%, and 22% reported loss of work for durations of 49.3 +/- 47.5, 50.90 +/- 103.3, and 29.25 +/- 56.5 days, respectively, within the previous year. CONCLUSION: Rheumatic disorders are common causes of morbidity, disability, and work loss in rural and urban communities of Bangladesh. Women are affected more frequently than men. Mechanical disorders are more common than inflammatory arthropathies.

China

1. Chen SL, Xius DO, Bao CD, Liu QY. COPCORD Study in Shanghai. APLAR Rheumatology. Eds. Nasution AR, Darmawan J. Churchil Livingstone Tokyo. 1992:393-395.

2. Richard D. Wigley, Zhang Nai Zheng, Zeng Qingyu, et al. Rheumatic Diseases in China: ILAR-China Study Comparing the Prevalence of Rheumatic Symptoms in Northern and Southern Rural Populations. The Journal of Rheumatology 1994;21(8):1484~1490.

3. Chen S, Du H, Wang Y, Xu L.The epidemiology study of hyperuricemia and gout in a community population of Huangpu District in Shanghai. Chin Med J (Engl) 1998;111: 228-230.

4. Dai SM, Han XH, Zhao DB, Shi YQ, Liu Y, Meng JM.. Prevalence of rheumatic symptoms, rheumatoid arthritis, ankylosing spondylitis, and gout in Shanghai, China: a COPCORD study.
J Rheumatol. 2003; 30: 2245-51.

5. Zeng Qing Yu,Wang Qing Wen, Chen Ren, et al. Primary gout in Shantou: a clinical and epidemiological study. Chinese Medical Journal 2003; 116(1): 66~69.

6. Zeng Qing-yu, Chen Ren, Xiao Zheng-Yu, Huang Shao-bi, Liu Yuan, Xu Jing-cai, Chen Shun-le, John Darmawan, RD Wigley, KD Muirden. Low prevalence of knee and back pain in southeast China; the Shantou COPCORD study. J Rheumatol. 2004; 31: 2439-43.

7. Wu ZB, Zhu P, Wang HK, Zheng ZH, Jia Y, Ding J, Leng N, Zhang HQ, Liu L. [Prevalence of seronegative spondyloarthritis in the army force of China.]
Zhonghua Liu Xing Bing Xue Za Zhi. 2004 Sep;25(9):753-5. Chinese.

8. Zeng QY, Darmawan J, Xiao ZY, Chen SB, Chen R, Lin K, Wigley R, Chen SL, Zhang NZ. Risk factors associated with rheumatic complaints: a WHO-ILAR COPCORD study in Shantou, Southeast China. J Rheumatol. 2005; 32: 920-7.
Zeng QY, Darmawan J, Xiao ZY, Chen SB, Chen R, Lin K, Wigley R, Chen SL, Zhang NZ. Risk factors associated with rheumatic complaints: a WHO-ILAR COPCORD study in Shantou, Southeast China. J Rheumatol 2005 May;32(5):920-7.
OBJECTIVE: To validate the differences of the prevalence of rheumatic symptoms between the north and south part of China and to investigate the associated risk factors for rheumatic complaints in Shantou, China. METHODS: Four samples together comprising 10,638 people > or = 16 years of age were surveyed in 1987, 1992, 1995, and 1999. The protocol of the ILAR-China Collaborative Study or the WHO-ILAR COPCORD Core Questionnaire was implemented. Data on rheumatic symptoms that were part of these surveys were collected and analyzed. RESULTS: The prevalence rate of rheumatic complaints was increasing in the Shantou area during the recent decade (in 1987 11.6%, 1992 12.5%, 1995 16.0%, and 1999 19.8%). However, it was still lower than the rate in Beijing, China, in 1987 (40.0%). Rheumatic symptoms were more prevalent in women than in men, and were more frequently seen in the elderly than in young people. The most frequently involved site was the low back followed by the knee and neck. Lumbar pain was more frequent among rural residents, while neck pain was more prevalent in the urban school-age population group. The prevalence of knee pain was significantly higher in people living in multi-story buildings without elevators compared with those living in single-story houses. The peak value of bone mineral density (BMD) in the Shantou population was 0.839 +/- 0.085 g/cm2 in men, and 0.723 +/- 0.064 g/cm2 in women, significantly higher than that reported in 13 other provinces and cities of China including Beijing. The sense of seeking a physician's care was higher in the population with a higher prevalence of rheumatic symptoms than that in the group with a lower prevalence of complaints. However, no significant difference was found in the rate of disability among the different population samples. CONCLUSION: The prevalence rate of rheumatic complaints was lower in Shantou than in Beijing. Socioeconomic status, environmental differences (e.g., Shantou in the southern and Beijing in the northern part of China), sex, age, occupation, ergonomics, BMD, and awareness of seeking medical care might all be risk factors associated with the prevalence of rheumatic complaints.
Zeng QY, Chen R, Xiao ZY, Huang SB, Liu Y, Xu JC, Chen SL, Darmawan J, Couchman KG, Wigley RD, Muirden KD. Low prevalence of knee and back pain in southeast China; the Shantou COPCORD study. J Rheumatol. 2004 Dec;31(12):2439-43.
OBJECTIVE: To determine whether the previously noted low prevalence of knee pain (KP) and lumbar pain (LP) in rural southern China compared with the high prevalence observed in North China was also true in a southern urban population. METHODS: A population based sample of 2040 adults > or = 16 years of age was studied in Chenghai City, close to the rural area previously studied on the southeast coast of China. Primary healthcare workers administered the COPCORD Phase I and II questionnaires. Those with rheumatic symptoms were recalled for medical examination, with a response rate at examination (phase III) of 98.4%. Those suspected of having arthritis had radiographs and laboratory tests. Prevalences were age and sex adjusted to the total of populations previously reported. RESULTS: (1) The prevalence for all rheumatic symptoms at phase III was 18.1%. Of the 7.5% with KP, 55% had osteoarthritic changes on radiograph (KOA) compared with 29% of a sample with no KP (p < 0.001). Of the 11.5% with LP, 69% had degenerative changes on lumbar spine radiograph (LOA). (2) Of residents in single-level houses the prevalence was 5.6% for KP and 7.9% for LP, whereas in 4 to 6-level apartment buildings these rates were significantly higher, 9.1% and 16.2%, respectively. All these pain rates were significantly lower than noted in rural North China. The prevalence of pain together with radiographic OA changes in the knee (KOA) was half the rate in single-floor residents (2.7%) compared to apartment residents (5.3%), as was lumbar spine degenerative disease (5.3% vs 11.5%). CONCLUSION: The prevalence of knee and lumbar spine pain in this southern urban sample was confirmed to be much lower than in the rural sample in the North, although higher than in the rural sample in the South. Comparing COPCORD studies of Han Chinese in Shanghai and Malaysia there was a decrease in prevalence of knee and back pain with latitude, suggesting an association with climate. Knee and back pain and radiological degenerative changes in the knee and lumbar spine were twice as prevalent in apartment residents than in those living in older single-level houses. Further study is needed to explain these observations.
Wu ZB, Zhu P, Wang HK, Zheng ZH, Jia Y, Ding J, Leng N, Zhang HQ, Liu L.
[Prevalence of seronegative spondyloarthritis in the army force of China.]
[Article in Chinese]. Zhonghua Liu Xing Bing Xue Za Zhi. 2004 Sep;25(9):753-5.
OBJECTIVE: To investigate the prevalence and epidemiologic characteristics of seronegative spondyloarthritis (SpAs) in Chinese army force in different areas. METHODS: 4-phase survey was conducted in 21 750 Chinese army, including: face-to-face interviews with standardized COPCORD questionnaires (Phase I screening); further examination on the suspected cases; identification of inflammatory joint and spinal diseases (Phase II); identification of SpAs (AS and uSpA) by more than two experienced specialists in rheumatology; further examination with X-rays and laboratory detection of HLA-B27 (Phase III); and data analysis (Phase IV). RESULTS: Among 21 750 army men, 21 cases of RA, 106 cases of SpAs were identified, with prevalence rates of 0.966 per thousand, 4.87 per thousand respectively. In 106 cases of SpAs, there were 46 cases of ankylosing spondylitis (AS), 52 cases of undifferentiated SpAs (uSpAs) with the prevalence rates of 2.11 per thousand and 2.39 per thousand respectively. Few cases of reactive arthritis (ReA) and Reiter's syndrome (RS) were identified (6 and 1 cases respectively). The prevalence of AS, uSpAs were higher in navy than that in the ground force or the air force. Soldiers in cold and damp areas had higher prevalence rates than that in the plain and drought areas. CONCLUSION: The prevalence of SpA (especially AS and uSpA) in Chinese army force was similar to that in the civilians. SpA (AS and uSpA) was more prevalent seen in the Navy. The incidence of SpA (AS and uSpA) was influenced by environmental factors such as coldness and dampness.
Dai SM, Han XH, Zhao DB, Shi YQ, Liu Y, Meng JM. Prevalence of rheumatic symptoms, rheumatoid arthritis, ankylosing spondylitis, and gout in Shanghai, China: a COPCORD study. J Rheumatol. 2003 Oct;30(10):2245-51.
OBJECTIVE: To carry out a cross-sectional survey on prevalence of musculoskeletal symptoms, rheumatoid arthritis (RA), ankylosing spondylitis (AS), and gout. METHODS: In Shanghai, 4 communities comprising 7603 inhabitants over 15 years of age in an urban population were randomly selected from 13 communities. Interviews were conducted from September 1997 to March 1998 by trained physicians using the COPCORD Core Questionnaire. Physical and radiographic examinations and serologic tests were carried out when required to classify categories of rheumatic diseases. The diagnoses of RA, systemic lupus erythematosus (SLE), and gout were based on American Rheumatism Association criteria. The diagnosis of AS strictly followed the modified New York criteria of 1984. Crude prevalence rates were standardized according to a standard Chinese population for age and sex structure. RESULTS: A total of 6584 adults (3394 women, 3190 men) were interviewed, and response rate was 86.6%. The age and sex standardized prevalence rate of rheumatic symptoms at any site amounted to 13.3% (95% CI 12.5-14.1%). Symptoms occurred more frequently in the following sites: knee 7.0% (95% CI 6.4-7.6%), lower back 5.6% (95% CI 5.0-6.2%), shoulder 4.7% (95% CI 4.2-5.2%), and neck 2.4% (95% CI 2.0-2.8%). Women complained of rheumatic symptoms more frequently than men. The standardized rates of RA, AS, gout, symptomatic knee osteoarthritis, and soft tissue rheumatism were 0.28% (95% CI 0.15-0.41%), 0.11% (95% CI 0.03-0.19%), 0.22% (95% CI 0.11-0.33%), 4.1% (95% CI 3.6-4.6%), and 3.4% (95% CI 3.0-3.8%), respectively. Two cases of SLE, one case of dermatomyositis, and one case of systemic sclerosis were found. CONCLUSION: Compared with rates in European and Western countries the prevalence rates of RA, AS, and gout are low in Shanghai, China, although the prevalence rates of rheumatic symptoms are high.

India

1. Rural COPCORD, Bhigwan, Pune, India. Reference: Chopra A. Longitudinal measurement of structure, function and psychosocial status (RA). Function feasibility issues in APLAR. APLAR Proceeding 1996; S186.

2. Chopra A, Patil J, Billempelly V, Relwani J, Tandle HS.Prevalence of rheumatic diseases in a rural population in western India: a WHO-ILAR COPCORD Study.
J Assoc Physicians India. 2001; 49: 240-6.

3. Chopra A, Saluja M, Patil J, Tandale HS. Pain and disability, perceptions and beliefs of a rural Indian population: A WHO-ILAR COPCORD study. WHO-International League of Associations for Rheumatology. Community Oriented Program for Control of Rheumatic Diseases. J Rheumatol. 2002; 29: 614-21.
Chopra A, Saluja M, Patil J, Tandale HS. Pain and disability, perceptions and beliefs of a rural Indian population: A WHO-ILAR COPCORD study. WHO-International League of Associations for Rheumatology. Community Oriented Program for Control of Rheumatic Diseases. J Rheumatol. 2002 Mar;29(3):614-21.
OBJECTIVE: The WHO-ILAR Community Oriented Program for Control of Rheumatic Diseases (COPCORD) primarily aims to estimate the burden of rheumatic-musculoskeletal symptoms/disorders (RMS). We investigated data on pain and disability, perceptions and beliefs in the first rural community based COPCORD study in India. METHODS: A total of 4092 adults were interviewed (response rate 89%) in a population survey (Stage 1) in Bhigwan village in 1996 using modified COPCORD core questionnaires. Twenty-one trained volunteers completed the survey in 5 weeks. Those reporting RMS were identified (Phase 1) to complete a self-evaluation questionnaire (Phase 2) prior to rheumatological evaluation (Phase 3). Phase 2 included questions on perceptions and beliefs regarding pain, effect on life, work and socioeconomic factors, disability, and therapy; only the moderate and severe grades were considered significant. Patients marked their pain sites on a manikin during the presurvey week. A validated modified Health Assessment Questionnaire disability index (HAQDI) in the local language evaluated functional disability. RESULTS: RMS were the predominant ailments reported by 746 adult villagers (18.2%; 95% CI 17.1, 19.2). Moderate pain of > 2 years' duration was reported by almost 60% of RMS patients. Neck (6%), lumbar (11.4%), shoulder (7.4%), elbow (6.5%), wrist (6.4%), hand (6.1%), knee (13.2%), calf (6.6%), and ankle (6.5%) were the common painful sites, predominantly in women; 91%, 89%, and 31% with RMS reported a significant grade of pain, RMS illness, and disturbed sleep, respectively. In the age group 25-54 years, 21% of those with RMS perceived a significant effect on work ability, while less than 20% of those with RMS admitted a similar effect on their personal life (including finances). About 10% with RMS had ceased to work because of RMS. Among RMS subjects 21% scored a significant HAQDI, but many more reported significant difficulty (HAQ) in the individual items of walking, hygiene (squatting), arising (from sitting cross-legged), reaching, and occupational/household chores; this corresponded to the dominant pain sites in low back and lower limbs. Oral tobacco use was reported to be significantly greater (p < 0.001) in the RMS patients. Past trauma was recalled by 23% of patients, and many connected this to their RMS. Modern medicines were consumed by 55% of patients with RMS. Among patients, 86% and 65% expected "pain relief" and "cure," respectively, from their doctor; 23% of patients wanted greater sympathy and attention. However, 21% of patients had never visited a doctor and were only identified by the COPCORD study. CONCLUSION: The findings of this study (1) demonstrate that RMS, although a predominant ailment, has a modest effect on daily living in most subjects with RMS; (2) indicate there is inconsistency between the measures of pain and disability (using HAQ) and their effects; (3) describe the beliefs and expectations of the community. Based on the data and community support, the COPCORD has been continued for Stages II and III, especially with a view to health education.
Chopra A, Patil J, Billempelly V, Relwani J, Tandle HS. Prevalence of rheumatic diseases in a rural population in western India: a WHO-ILAR COPCORD Study. J Assoc Physicians India. 2001 Feb;49:240-6.
BACKGROUND: COPCORD (Community oriented program from control of rheumatic diseases) is a global initiative of the WHO/International League of Associations from Rheumatology (ILAR). The prevalence data from the first Indian COPCORD survey (Stage 1), carried out in village Bhigwan (Dist. Pune), in 1996, is presented. AIM: To study the rural prevalence of rheumatic-musculoskeletal symptoms/diseases (RMSD). METHODS: A cross-sectional survey of the village (non-randomised selection) was completed in five weeks, using validated questionnaires, served by 21 trained volunteers. 746 patients (18.2%, 95% CI: 17-1-19-4) were identified (Phase 1) from 4092 adults (response 89%), and systematically evaluated (Phase 2 and 3) by a medical team, including a rheumatologist; limited investigations were carried out and diagnosis confirmed during a planned 12 week initial follow-up. Standard clinical criteria were used for the diagnosis; point prevalence estimates (prev)/confidence interval (CI) are shown in parenthesis. RESULTS: There was a dominant distribution of 'pain at all sites' (articular/soft tissues) in the females; painful neck (9.5%), back (17.3%), and calf (8.5%) appeared significant when compared to the Bhigwan males and the Indonesian and the Chinese rural COPCORD results. 55% RMSD were due to soft tissue rheumatism (5.5%) and an ill-defined/unclassifiable symptom-related-diagnosis (7.1%). Osteoarthritis (5.8%) and inflammatory arthritis (IA) were seen in 29% and 10% patients respectively. 240 patients (5.9%) with chronic knee pains did not show any clinical evidence of OA. The prev of rheumatoid arthritis (0.5%, 95% CI: 0.3-0.7), as classified by the American College of Rheumatology, was the highest ever reported from an Asian rural COPCORD study. Though unclassifiable IA (0.9%, 95% CI: 0.6-1.1) was seen, well defined reactive arthritis, TB, leprosy and connective tissue disorders were not observed. Gout was diagnosed in five patients (0.12%). CONCLUSIONS AND DISCUSSION: The Bhigwan COPCORD survey demonstrates a significant rural spectrum of RMSD. It provides a reasonable speculation about the Indian rheumatological burden. Further, an eight year prospective study is in progress to identify new cases and risk factors, and educate people (Stages 2 and 3).

Indonesia

1. Darmawan J, Valkenburg H A, Muirden K D, Wigley R D. Epide­miology of Rheumatic Diseases in rural and urban populations in Indonesia: a World Health Orga­nization International League Against Rheuma­tism COPCORD study, stage I, phase 2. Ann Rheum Dis 1992; 51: 525-528.

2. Darmawan J, Valkenburg HA, Muirden KD, Wigley RD. Arthr­itis community education by leather puppet (wayang kulit) shadow play in rural Indonesia (Java) Rheumatology Internat 1992;12: 97-101.

3. Darmawan J. Valkenburg HA Muirden KD Wigley RD :The epidemiology of gout and hyperuricemia in a rural population of Java. J Rheumatol 1992; 19: 1595-1599.

4. Darmawan J, Valkenburg HA, Muirden KD, Wigley RD. The epidemiology of rheumatoid arthritis in Indonesia. Brit J Rheum 1993; 32: 537-540.

5. Darmawan J, Valkenburg HA, Muirden KD, Wigley RD, Eudering F. Nodules of the shoulder girdle in two Indonesian villages. Rheumatol Int 1993; 12: 247-50.

6. Darmawan J Lutalo SK. Gout and hyperuricaemia. Baillieres Clin Rheumatol 1995; 9: 83-94.

7. Darmawan J, Muirden KD, Valkenburg HA, Wigley RD. The prevalence of Soft Tissue Rheumatism in Indonesia – a WHO-ILAR COPCORD Study. Rheumatology Internat 1995;15: 121-124.

8. Darmawan J, Ferraz MB, Muirden KD, Tugwell P.Case study: World Health Organization-International League of Associations for Rheumatology Community-Oriented Programme for the Control of Rheumatic Diseases (WHO-ILAR COPCORD) in Indonesia and Brazil. Int J Technol Assess Health Care. 1995; 11: 700-8.

9. Darmawan J, Rasker JJ, Nuralim H. Reduced burden of disease and improved outcome of patients with rheumatoid factor positive rheumatoid arthritis compared with dropouts. A 10 year observational study. J Rheumatol Suppl. 2003 Aug; 67: 50-3.

10. Darmawan J, Rasker JJ, Nuralim H. The effect of control and self-medication of chronic gout in a developing country. Outcome after 10 years. J Rheumatol. 2003 Nov; 30(11): 2437-43.

11. Darmawan J, Rasker JJ, Nuralim H. Ten years radiographic outcome of rheumatoid factor positive rheumatoid arthritis patients, treated with immunosuppressive combination therapy. J Rheumatol. In press 2004 March 31:
Darmawan J, Valkenburg HA, Muirden KD, Wigley RD.The prevalence of soft tissue rheumatism. A WHO-ILAR COPCORD study. Rheumatol Int. 1995;15(3):121-4.
TheThe prevalence of various forms of soft tissue rheumatism, including painful low back syndrome (PLBS), painful restricted shoulder syndrome (PRSS), and epicondylitis without an underlying specific rheumatic disease, and the resultant loss of time from work were determined in a total population of 4,683 rural and 1,103 urban subjects aged 15 years and over in Central Java, Indonesia. In the rural study, 763 respondents with, and 355 respondents without complaints were examined. The urban survey evaluated 925 subjects. Prevalence rates in the rural and urban subjects were 20.0% and 25.8%, respectively, for PLBS, 14.5% and 16.2%, respectively, for PRSS, and 5.8% and 7.5%, respectively, for epicondylitis. Lost time from work in the rural and urban subjects was 9% and 2.2%, respectively, for PLBS, 5% and 1.1%, respectively for PRSS, and 2% and 1.3%, respectively for epicondylitis. The mean number of lost work days per year in the rural and urban subjects were 15.3 and 21.1, respectively, for PLBS, 8.1 and 15.2, respectively, for PRSS, and 3.9 and 2.3, respectively for epicondylitis. Thus, these forms of soft tissue rheumatism exerted significant effects on community life, apart from causing pain and discomfort. Work days lost directly means diminished income in populations lacking any form of unemployment benefits.
Darmawan J, Valkenburg HA, Muirden KD, Wigley RD. Epidemiology of rheumatic diseases in rural and urban populations in Indonesia: a World Health Organisation International League Against Rheumatism COPCORD study, stage I, phase 2. Ann Rheum Dis. 1992 Apr;51(4):525-8.
To determine the incidence of musculoskeletal pain, disabilities, and help seeking behaviour, a questionnaire was administered to a rural population of 2184 men and 2499 women and an urban population of 481 men and 590 women aged over 15 years by house to house interviews with completion rates of 95.2% (rural) and 97.1% (urban). The incidences of pain in the joints, back, or neck were 23.6% (rural) and 31.3% (urban). The incidence of disability due to an inability to walk, lift, carry, and dress was 2.8% (rural) and 0.9% (urban). The percentage of the population with pain who had to stop work owing to disability was 75% (rural) and 78% (urban). Official health care facilities were used by 62% (rural) and 71% (urban) of the population. Traditional health care was used by 87% (rural) and 89% (urban). The high percentage of subjects unable to work was due to a predominance of manual labour occupations (rural, 90%, urban, 80%). The age and sex specific incidence of rheumatic diseases in these populations were similar to other developing and developed countries. The primary rheumatology service was inadequate due to the low priority given by the health service to non-communicable diseases and inadequate rheumatology teaching of the primary health care doctors during undergraduate training. Musculoskeletal pain is a major public health problem in Indonesia and is still not fully appreciated.
Darmawan J, Muirden KD, Wigley RD, Valkenburg HA. Arthritis community education by leather puppet (wayang kulit) shadow play in rural Indonesia (Java). Rheumatol Int. 1992;12(3):97-101.
As part of the WHO/International League Against Rheumatism (ILAR) sponsored community organized programme for the control of rheumatic disease (COPCORD), an arthritis community education programme (ACE) was undertaken utilizing the traditional form of entertainment in a rural area in Central Java-the wayang. The point prevalence rate of musculoskeletal complaints was estimated in 4683 men & women aged 15 years and over by house-to-house interviews. From 1105 respondents recording recent musculoskeletal pain, 844 were randomly selected and half the latter attended a puppet shadow play (wayang) incorporating the ACE. The other half, matched for age, sex and educational level who did not see the play, served as controls. A questionnaire containing biphasic choices of correct or incorrect ways of performing activities of daily living (ADL) to minimize musculoskeletal problems was administered to the whole group before, 1 month and 6 months after the wayang. Increased knowledge of correct ways of performing ADL (correct ADL) in the intervention group compared with the control group at 1 and 6 months after wayang was significant (P less than 0.05). Comprehension of correct ADL following the wayang could be demonstrated even in subjects who were illiterate and those who had attended primary school only. Retention of knowledge at the 6 month assessment declined more markedly in the illiterate group. ACE by wayang was shown to be feasible and effective in transferring knowledge on ADL to people with musculoskeletal problems in the sample population in Java. This effect could be shown even in the poorly educated section of the community.

Iran

1. F. Davatchi. Iran COPCORD Study. APLAR 2004 Proceedings Book. The 11th Asia Pacific League of Associations for Rheumatology Congress. Korea, Jeju, September 11­15, 2004, pp 89-91.
Fereydoun Davatchi, Ahmad-Reza Jamshidi, Arash Tehrani Bani-Hashemi, Maziar Moradi, Jaleh Gholami, Farideh Samadi, Mehrzad Hadj-Aliloo, Koorosh Ghaznavi, Mohsen Soroosh, Bahareh Ghaderi, Parinaz Abyari. Rheumatology Research Center, Tehran University for Medical Sciences, Shariati Hospital, Tehran, Iran. Iran COPCORD Study. APLAR 2004 Proceedings Book. The 11th Asia Pacific League of Associations for Rheumatology Congress. Korea, Jeju, September 11­15, 2004, pp 89-91.
OBJECTIVE. To test the feasibility of a COPCORD survey. MATERIALS AND METHODS: Tehran with 1/10th of the population of Iran of mixed ethnic origin was selected. It is representative of the ethnic distribution of the country. Subjects were randomly selected from the 22 districts. Interviewers were selected from BS certified nurses and midwives. Physicians were selected from subspecialty fellows of Rheumatology. Both groups completed different levels of training courses for the survey. RESULTS: The pilot study was completed in one day, from 9 AM to 6:30 PM. One hundred sixty eight houses were visited and 284 subjects with age range of 15-82.5 and mean age of 39.2 years were interviewed. The male to female ratio was 0.87 to 1.00. The ethnic distribution was Caucasians 66.2%, Turks 32%, and Semites 1.8%. Musculoskeletal complaints during the past 7 days were detected in 45.4% of the interviewed subjects. Distribution was: shoulder 18.3%; wrist 13.4%; hand 15.1%; hip 10.2%; knee 26.1%; ankle 12.7%; big toe 11.6%; cervical spine 13.7%; dorsal and lumbar spine 22.2%; others 12.3%. Degenerative Joint Disease was detected in: neck 0.70 %; lumbar spine 0.70%; knee 9.76%; others 2.44%; multiple joints 2.09%. Others were: low back pain 2.79%; sciatica 0.35%; tennis elbow 0.70%; shoulder tenosynovitis 0.70%; tendonitis and tenosynovitis 1.06%. No inflammatory disorder was encountered. Disability was reported by 23.9%. CONCLUSION: The pilot study warrants a COCPORD survey covering 10.000 subjects to acquire prevalence rate of Rheumatoid Arthritis with adequate statistical power. KEYWORDS: COPCORD, Iran, Rheumatic Diseases, Community-based Epidemiology.

Kuwait

1. Al-Awadhi A, Olusi S, Moussa M, Al-Zaid N, Shehab D, Al-Herz A, Al-Jarallah K, Al-Salem I, Pedro A. Validation of the Arabic Version of the WHO-ILAR COPCORD Core Questionnaire for Community Screening of the Rheumatic Diseases in Kuwaitis. The Journal of Rheumatology 2002; 29: 1754-9.

2. Al-Awadhi AM, Olusi SO, Moussa M, Shehab D, Al-Zaid N, Al-Herz A, Al-Jarallah K. Musculoskeletal pain, disability and health-seeking behavior in adult Kuwaitis using a validated Arabic version of the WHO-ILAR COPCORD Core Questionnaire. Clin Exp Rheumatol. 2004 Mar-Apr; 22(2):177-83.
Al-Awadhi AM, Olusi SO, Moussa M, Shehab D, Al-Zaid N, Al-Herz A, Al-Jarallah K. Musculoskeletal pain, disability and health-seeking behavior in adult Kuwaitis using a validated Arabic version of the WHO-ILAR COPCORD Core Questionnaire. Clin Exp Rheumatol. 2004 Mar-Apr; 22(2): 177-83.
OBJECTIVE: The WHO-ILAR Community Oriented Program for Control of Rheumatic Diseases (COPCORD) primarily aims to estimate the burden of musculoskeletal symptoms/disorders. We investigated data on musculoskeletal pain, disability and health-seeking behavior in the first community-based COPCORD study in Kuwait. METHODS: The validated Arabic version of the WHO-ILAR COPCORD Core Questionnaire was used in 2,500 randomly selected Kuwaiti households. The target population comprised Kuwaiti nationals aged 15 years and older. Twenty-four trained field workers completed the survey in 8 weeks. Those subjects reporting musculoskeletal pain were identified (Phase 1), and were asked to complete a self-evaluation questionnaire (Phase 2) prior to rheumatological examination (Phase 3). Phase 2 included questions on the site and severity of pain, traumatic events, functional disability, and treatment. Patients marked their pain sites on a mannequin during their interviews. "Sufferers" were defined as those with musculoskeletal pain and no history of trauma. RESULTS: A total of 7,670 adults were interviewed (response rate 88%), of whom 2,057 had musculoskeletal pain not related to trauma. Knees, back, and shoulders were the common sites of pain. Most of the sufferers reported the severity of pain as being moderate to severe. Functional disability was reported in 39.1% of the sufferers. The age-sex population adjusted prevalence rate for musculoskeletal pain was 35.7% in females and 20.2% in males. The most common sources for advice on treatment were physicians in hospitals (68.8%) and general practitioners (30.4%). 82% had prescriptions for their medications, while 19.4% had self prescribed tablets. CONCLUSION: Musculoskeletal pain is a major health problem among Kuwaitis and deserves intense government attention.

Malaysia

1. Veerapen K. Epidemiology of rheumatic disease in Malaysia. APLAR Rheumatology. Ed Urban COPCORD study completed. Eds. Nasution AR, Darmawan J. Churchil Livingstone Tokyo 1992:297-399.


Pakistan

1. Farooqi A, Gibson T. The prevalence of major rheumatic disorders in the adult population of Northern Pakistan. APLAR Proceeding 1996; S181.

2. Farooqi A, Gibson T. Prevalence of major rheumatic diseases in the adult population of north Pakistan. Br J Rheumatol 1998; 37: 491-5.

The Philippines

1. Manahan L, Caragay R, Muirden KD, Allander D, Valkenburg HA, Wigley RD. Rheumatic pain in a Philippine village. Rheumatology Internat 1985; 5:149-53.

2. Wigley RD, Manahan L, Muirden KD, Caragay R, Pinfold B, Couchman KG, Valkenburg HA. Rheumatic disease in a Philippine village II: a WHO-ILAR-APLAR COPCORD study, phases II and III. Rheumatology Internat 1991; 11: 157-161.

3. Dans LF, Tankeh-Torres S, Amante CM, Penserga EG. The prevalence of rheumatic diseases in a Filipino urban population: a WHO-ILAR COPCORD Study. J Rheumatol 1997; 24: 1814-1819.
Dans LF, Tankeh-Torres S, Amante CM, Penserga EG. The prevalence of rheumatic diseases in a Filipino urban population: a WHO-ILAR COPCORD Study. World Health Organization. International League of Associations for Rheumatology. Community Oriented Programme for the Control of the Rheumatic Diseases. J Rheumatol. 1997 Sep;24(9):1814-9.
OBJECTIVE: To determine the point prevalence of musculoskeletal complaints and rheumatic diseases in a Filipino urban community. METHODS: A descriptive cross-sectional 2 phase survey was conducted in an urban community in Metropolitan manila. Phase I (screening) used face-to-face interviews, while phase II (examination) involved case identification of the rheumatic diseases. We sampled 670 households (3065 adults) using a multistage cluster sampling method. A pilot study was conducted to pretest the questionnaire for cross-cultural adaptation and validation, field procedures, sampling design, and data management plan. Standardized translated COPCORD questionnaires (blind translation and blind back-translation) were administered by trained interviewers. Two weeks after Phase I, Phase II was conducted at local health centers. The COPCORD questionnaire screened the number of cases with musculoskeletal complaints. Identification of cases with rheumatic disease was based on American College of Rheumatology (ACR) criteria. RESULTS: Respondents completed 3006 questionnaires (phase I response rate 98%). Of these 489 respondents had musculoskeletal complaints. Functional disability was reported in 25% among these respondents. We examined 353 (phase II response rate 72%), revealing 294 with rheumatic conditions. In 26 persons there were no abnormalities, while 32 had nonrheumatic conditions at examination. The most common rheumatic diseases were osteoarthritis (OA) (n = 124) and soft tissue rheumatism (n = 115). CONCLUSION: The prevalence of musculoskeletal complaints was 16.3% (95% CI 8.6-24.0) of the adult population in a FIlipino urban community. The total prevalence of rheumatic disease is 9.8% (95% CI 8.2-11.4). The prevalence of OA was 4.1% (95% CI 3.3-4.9) and soft tissue rheumatism 3.8% (95% CI 2.9-4.8). The prevalence of rheumatoid arthritis, 0.17% (95% CI 0-9.36), was notably low compared to the prevalence in other developing countries.
Wigley R, Manahan L, Muirden KD, Caragay R, Pinfold B, Couchman KG, Valkenburg HA. Rheumatic disease in a Philippine village. II: a WHO-ILAR-APLAR COPCORD study, phases II and III. Rheumatol Int. 1991;11(4-5):157-61.
Many difficulties were encountered in a population survey of rheumatic complaints in a remote village area in the Philippines affecting the reliability of estimates of population prevalence. In phase I, a simple questionnaire identified 269 adults out of 950 who had rheumatic symptoms. In Phase II, 234 or 87% of positive respondents were requestioned using a more detailed pro forma. There were 196 with peripheral joint pain, 67 with neck pain and 137 with back pain. One third attributed their symptoms to work and 127 subjects had to stop work because of their complaints. Disability, including an inability to carry loads, affected nearly 1.8% of the population. Questions designed to detect rheumatoid arthritis and gout were not satisfactorily answered. Of those with complaints, 82% indicated that they still required help for their symptoms. In phase III, 166 subjects were medically examined. Osteoarthritis of the knee was found in 25 and 17 had Heberden's nodes. There were 16 with epicondylitis; 16 had rotator cuff pain and 35 had levator scapulae insertion pain. Three of these and three others had neck or shoulder swellings related to carrying loads on poles. Definite rheumatoid arthritis was diagnosed in two subjects and gout in five. No case of ankylosing spondylitis was identified. Thus, rheumatic complaints were common in this rural community and were frequently severe enough to cause disability and loss of time from work. Health worker education is required on how to handle these problems.
Manahan L, Caragay R, Muirden KD, Allander E, Valkenburg HA, Wigley RD. Rheumatic pain in a Philippine village. A WHO-ILAR COPCORD Study. Rheumatol Int. 1985;5(4):149-53.
In initiating a community oriented programme for the control of rheumatic disease (COPCORD), 1685 people of all ages from a rural area in the Philippines were questioned by primary health care workers (PHW) for limb and spinal rheumatic pain and disability. The total complaint rate was 15.3% for men and 18.5% for women. For those 15 years and older the age adjusted rheumatic pain rates for pain present at the time of survey were 28.4% for the Philippines and 22.6% for Lawrence's UK population. The most common rheumatic pain sites in this community were knee, lumbar spine, neck and the trapezius muscle. The disability rate was 4.5% for those 15 years and older. One quarter of those with pain had received medical attention and the remainder, herbal treatment, massage, various faith and/or self-treatment methods.

Thailand

1. Chaiamnuay P, Darmawan J, Muirden KD, Assawatanabodee P. Epidemiology of Rheumatic Disease in Rural Thailand: a WHO-ILAR COPCORD Study. J Rheumatol 1998; 25: 1382-1387.
Chaiamnuay P, Darmawan J, Muirden KD, Assawatanabodee P. Epidemiology of rheumatic disease in rural Thailand: a WHO-ILAR COPCORD study. J Rheumatol. 1998 Jul;25(7):1382-7.
OBJECTIVE: To determine the prevalence rates of musculoskeletal disorders in a rural population of Thailand. METHODS: Nurses applied the WHO-ILAR COPCORD Core Questionnaire to 2463 rural subjects 15 years of age and over. Respondents who had current musculoskeletal pain were examined by 2 rheumatologists within one week after the interview survey. Radiographic and serologic examinations were carried out when required to classify categories of rheumatic disease. RESULTS: Response rates of the interview survey and examination were 99.7 and 94.2%, respectively. Musculoskeletal pain ever by interview was found in 36.2% of respondents. Of these, 22.7, 12.5, 6.5, and 5% had back, knee, hip region, and neck pain, respectively. Four hundred thirty-one cases (17.6%) who had musculoskeletal pain within 7 days of the interview were examined by rheumatologists, who confirmed 12.8, 5.7, 0.08, and 3.4% had back, knee, hip, and neck abnormalities, respectively. Four hundred fifty-eight (18.6%) had past musculoskeletal pain. Total disability rate was 3%, comprising 3.3% in women and 2.6% in men. Treatment rates by self-medication for current and past musculoskeletal pain were 60.3% in women, 65.7% in men. Therapy was by physician 52.1%, paramedics 9.7%, and masseur 6.8%. The rates of disease prevalence were osteoarthritis 11.3%, myofascial pain syndrome 6.3%, low back pain 4.0%, arthralgia 3.2%, gout 0.16%, rheumatoid arthritis and seronegative spondyloarthropathy each 0.12%, and mixed connective tissue disease and unclassified autoimmune disease each 0.04%. CONCLUSION: Back and knee pain caused the greatest burdens of disease, resulting mostly from joint degeneration.

Vietnam

1. Minh Hoa TT, Darmawan J, Chen SL, Van Hung N, Thi Nhi C, Ngoc An T. An. Prevalence of the rheumatic diseases in urban Vietnam: a WHO-ILAR COPCORD study. J Rheumatol 2003; 30: 2252-2256.
Minh Hoa TT, Darmawan J, Chen SL, Van Hung N, Thi Nhi C, Ngoc An T.
Prevalence of the rheumatic diseases in urban Vietnam: a WHO-ILAR COPCORD study. J Rheumatol. 2003 Oct;30(10):2252-6.
OBJECTIVE: To determine the prevalence rates of musculoskeletal disorders in an urban Vietnamese population. METHODS: The Community Oriented Program for Control of Rheumatic Disease (COPCORD) Stage I study was carried out in 16 groups in the Trung Liet Commune, Dong Da District, Hanoi City, Vietnam. Phase 1: the WHO ILAR COPCORD Core Questionnaire was applied by primary health care workers to 2119 urban subjects aged 16 years and over. Phase 2: 276 positive responders who had musculoskeletal complaints were interviewed by nurses and examined one week later. Phase 3: 261 positive responders in phase II were examined by 3 rheumatologists and 38% of these subjects required radiographic and blood tests to classify rheumatic disease categories. RESULTS: The response rates were 94.4%, 86.2%, and 94.6% in phases 1, 2, and 3, respectively. The prevalence of musculoskeletal pain was 14.9%. The most common musculoskeletal complaints were knee pain 18.2%, low back pain 11.2%, and soft tissue disorder 15.4%. Functional disability was reported in 6.04% of the survey population. The prevalence of rheumatic diseases was OA 4.1%, rheumatoid arthritis 0.28%, osteoporosis 0.47%, connective tissue disease 0.09%, and gout 0.14%. CONCLUSION: The prevalence of musculoskeletal pain in 2119 adults in an urban population in Vietnam was 14.5%, and osteoarthritis was the most commonly found arthritis.​

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