3–15 Jan, 2000: A Report By
Dr Arvind Chopra, MD, Rheumatologist, Pune, India

Introduction
The launch of the WHO BJD 2000–2010 is a culmination of the efforts put in by numerous experts and visionaries to curb the growing menace of the rheumatic–and–musculoskeletal diseases (RMSD). These disorders, inclusive of the traumatic etiology, predominantly contribute to the morbidity across the globe, in terms of impaired quality of life (QOL). After having effectively launched several programs to control numerous communicable infectious diseases with a fair measure of success, over the decades, the WHO has now begun to increasingly focus on the non–communicable diseases. Among the latter, the cardiovascular disorders and cancers have preoccupied the health planners for reasons obviously connected to human longevity. But having realized that reduction in mortality must be matched with improved QOL, the WHO has now launched one its most ambitious programs, the WHO–BJD 2000–2010.

Initiated by the medical faculty of the Swedish University at Lund, the inaugural consensus meeting was held in April 1998 to set up an international steering group. Further, a proposal for a global collaboration by the latter was accepted by the WHO. Secretary General Kofi Annan, on behalf of the United Nations, has officially welcomed the WHO–BJD initiative, and has appealed to the World community in stating: ‘There are effective ways to prevent or treat these disabling conditions. But we must act on them (RMSD) now’.

The BJD is actually an umbrella organization of over 750 patient and professional organizations in the world concerned with bone and joint disorders. It is endorsed by the International League of Associations for Rheumatology (ILAR) and its components in Asia Pacific (APLAR), and the rest of the world. Numerous national organizations, including the Indian Orthopedic Association and the Indian Rheumatism Associations, have been listed among the organizations supporting the BJD movement. Over 17 governments have endorsed the WHO–BJD project.

The Government of India has yet to offer its official support.
The WHO proceeded to organize a scientific expert group meeting in Geneva, Switzerland, in January 2000 for the official launch of the BJD. To begin with, this meeting focused on five major disorders among the many that constitute RMSD. These were rheumatoid arthritis (RA), osteoarthritis (OA), osteoporosis, spinal disorders and severe limb trauma.

Background information and inaugural address
Arthritis accounts for over 50 per cent of all chronic conditions in persons aged 60 years and above. In over 25 per cent of the latter community, Osteoarthritis of the knees and spine, causes dominant pain and disability. Back pain, one of the commonest causes for seeking medical consultation, is the second leading cause of sick leave from work. About 10 to 20 per cent of the population visits the doctor for all kinds of soft tissue rheumatism and trauma related MSD, and the latter are often related to occupational overuse and/or misuse. {mospagebreak} Dr Jie Chen, Director, Non–Communicable Diseases Division, WHO, in her inaugural speech stated that currently there are about 12 million cases of rheumatoid heart disease (RHD) reported annually from all over the world. It must be added that RHD is caused by rheumatic fever arthritis, which if diagnosed early and treated appropriately is curable. Rheumatic fever arthritis, a post–bacterial disorder, is a preventable and a major scourge of the young population in developing countries.

It is anticipated that based on current trends, road traffic accidents (RTA), already in epidemic proportions, would compete with cardiac and vascular disorders and cancers to be among the leading causes of human mortality and morbidity by 2020. Almost, 7,00,000 people are killed globally by RTA, which are estimated to be the tenth leading cause of death (World Health Report, 1999). About 25 per cent of the health expenditure in developing countries is expected to be spent on trauma related care by the year 2010. Fragility fractures, due to osteoporosis, have doubled in the last decade, and it is estimated that over 40 per cent of all women over the age of 50 years (as women are more likely to suffer from osteoporosis after menopause) will suffer from an osteoporotic fracture. Prof Lars Lidgren, Chairman, BJD International Steering Committee, in his inaugural address stated that the number of hip fractures will further rise from 1.7 million in 1990 to 6.3 million by 2050 unless aggressive preventive programs are started.

In the inaugural address to the meet, Dr Gro Harlem Brundtland, Director General, WHO, stated that “The increased life expectancy recorded in recent decades, together with changes in lifestyle and diet, have led to a rise in non–communicable diseases (NCD), also in the developing countries. NCD now cause nearly 40 per cent of all deaths in the developing countries, where they affect younger people than in industrialized countries”. The latter underscores the significance of the NCD, including the WHO–BJD, all over the world.

Scientific Meeting
Over 70 expert participants belonging to different fields (Rheumatology, Orthopedics, Epidemiology, Social Sciences, Statistics, e–Conomics, Health Planning etc), from all over the world were invited. Prof Anthony Woolf, a rheumatologist from UK, was elected chairman of the meeting.

Prof Shanmugasundram, (Chennai, orthopedic surgeon), Dr Arvind Chopra (Pune, rheumatologist), Dr A Mittal (Delhi, endocrinologist), and Prof D Mohan (Delhi Trauma Expert), were invited from India. The participants were divided into five working groups, one each for RA, OA, trauma, osteoporosis and spinal disorders.
The two–day program consisted of key lectures and workshop–brain storming sessions to:

1. Review the existing epidemiological data on RMSD.
2. Achieve a consensus on disease definitions, staging and natural history.
3. Identify health and socioeconomic indicators of RMSD.
4. Identify gaps in the knowledge and understanding of RMSD.
5. Raise awareness of the BJD.

The currently available validated instruments to measure health status, disease outcome and overall QOL were discussed in detail for future adoption to measure the burden of disease, with particular reference to socio–economics. The disability–adjusted life year methodology (DALY), based on health and socio–economic indicators, was presented by WHO experts with a view to measure the RMSD burden quantitatively in a standardized manner from all countries irrespective of their development status. Similarly, DALY could be calculated for all diseases, and then be used to allot health expenditure priorities.

The WHO also presented the new classification nomenclature of diseases, their functioning and disability. The well known WHO model paradigm of impairment–disability–handicap to describe disease consequences will be replaced by the ‘Impairment–activity–participation’ model for better humane connotations and acceptance.

The conclusions of the five working groups, one for each of the major RMSD disorders described above, were presented, discussed and a consensus of the participants obtained. Differences in opinions were recorded. A research agenda was conceptualized. Items to be contained in the future strategy of BJD were discussed with a view to fill the ‘Gaps’ identified during this meeting through organized global effort, devise appropriate interventions for reduction in the RMSD burden and provide better health care and health. The WHO will publish the proceedings of the scientific meeting through a WHO Technical Report.