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Community based study to estimate prevalence, burden of illness and help seeking behavior in rheumatic diseases in Mexico City. A COPCORD study

M.H. Cardiel¹, J. Rojas-Serrano²

¹Department of Immunology and Rheumatology, ²Department of Internal Medicine, Instituto Nacional de Ciencias MŽdicas y Nutrición Salvador Zubirán, Mexico City, Mexico.

ABSTRACT
Objective
To estimate the prevalence, burden of illness and help seeking behavior of musculoskeletal complaints and provide point prevalence estimates of osteoarthritis, low back pain, fibromyalgia, rheumatoid arthritis and gout among adult population in a suburban community in Mexico city.

Methods
Home survey of adults in a balanced and stratified sample validated against physical exam. Three trained interviewers applied a validated COPCORD core questionnaire. Subjects with pain (in the last seven days or ever) ³ 4 (0-10) and no trauma; or with current or past disability were evaluated preferably the same day by a trained clinician in a structured interview. A diagnosis using ACR criteria when available, recommendation or referral was provided as required. Analysis was based on descriptive statistics of participant characteristics, pain site and distribution, patterns of help seeking behavior. Point prevalence with 95% confidence intervals of most common diseases and associated disability rate.

Results
1169 men and 1331 women were included. Pain in the last 7 days not associated with trauma was reported in 419 (17%) participants. The most common sites of involvement were knee (12.3%); low back (6.3%); ankles (6%) and shoulders (5.3%). The mean/SD pain score was 4.8/2.5. Thirteen percent of the total sample had some treatment. The general practitioner treated 72% of those; 75% perceived good efficacy with medications. Point prevalence estimates and 95% CI were: disability: 1.4% (0.0 – 1.9); osteoarthritis: 2.3% (1.7 – 2.9); fibromyalgia: 1.4 (1.0 – 2.0); low back pain: 6.3% (5.4 – 7.3); rheumatoid arthritis: 0.3% (0.1 – 0.6) and gout 0.4% (0.1 – 0.7).

Conclusion
Pain in the last 7 days due to musculoskeletal disorders is 17% in this community. Medications were commonly prescribed. Point prevalence estimates of most common diagnoses was similar to other community surveys using COPCORD methodology but very different help seeking behavior.

Key words
Epidemiology, rheumatic diseases, help seeking behavior, rheumatoid arthritis.

This work was supported by CONACYT (Grant # 0767P-M9506), a Mexican agency supporting science and technology.
Please address correspondence to: Mario H. Cardiel, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Colonia Sección XVI, Delegación Tlalpan 14000, Mexico City, Mexico.
E-mail: mcardiea@sni.conacyt.mx