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

Abstract

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.