The Indian Participation and Data
The epidemiological data on RMSD generated by the WHO COPCORD (community–oriented program for control of rheumatic disease) project in village Bhigwan, Dist. Pune, India, was accepted and listed in the BJD global data inventory. The Bhigwan COPCORD, the first of its kind in India, and seventh in the world, was launched in 1996, under the auspices of the WHO–ILAR–APLAR COPCORD by Dr Arvind Chopra, a consulting rheumatologist in Pune, India. The Bhigwan COPCORD 1996–2004 is the first ongoing prospective study of its kind in the world, and has provided prevalence and incidence figures of various types of RMSD from a 7,000 rural population
It was recognized during the WHO meeting under reference that the Bhigwan COPCORD had amply shown:
- About 13–14 per cent of the population reported RMSD symptoms and required medical care.
- Besides the five major RMSD entities under focus, soft tissue rheumatism problems (STR) are dominantly reported by almost 55 per cent of the RMSD rural patients, a fact that was endorsed by the participants for evaluation and inclusion in the BJD agenda. STR problems, dominantly reported by working female class, were largely due to occupational overuse, also called repetitive stress syndrome in this village. Psycho functional factors, especially anxiety, can also lead to a form of STR, often called fibromyalgia but the latter though found in the village population was much less. Overall, STR problems are preventable and amenable to treatment largely by appropriate health education.
- Almost 10 per cent of the RMSD patients had inflammatory arthritis, and that the prevalence of RA was almost 0.5–0.6 per cent in the Bhigwan population; the highest ever reported from a rural study of this kind.
- Almost 5.5–0.6 per cent of the village population suffer from osteoarthritis.
- Further, the COPCORD Bhigwan model for the study of the epidemiology of RA in a prospective manner, presented buy Dr Chopra initially to the working group on RA and later to the participants of the meeting, was adopted by the WHO BJD, in the place of the proposed model, for future application.
Prof Sunderam presented his statistics on spinal disorders based on hospital experience in Chennai, with special reference to spinal injuries and tuberculosis. He further described the problems of collecting hard core epidemiological data on spinal disorders in the Indian scenario. Dr Mittal expressed his concern on the lack of data on osteoporosis in developing countries, and further stated though the lack of technology did not allow precise diagnosis, the disease was rampant and often in association with Vitamin D deficiency. The latter was accepted by the participants.
Prof D Mohan, an engineer from IIT, New Delhi, and in charge of a WHO collaborating center on transportation injuries and prevention, cited his socio–economic–cultural data from village surveys carried out in North India, and further highlighted the etiology and prevention of thumb trauma. Besides RTA, he also emphasized the need to curb agricultural–related trauma in the developing countries.
At present, India does not have a national program of any kind concerning RMSD/rheumatic diseases.
The WHO–BJD Future Strategy
The key goal is summed up in its slogan “Keep people moving”. Based on the proceedings and conclusions of the recently conducted scientific expert group meeting in Geneva, and available world statistics, the WHO BJD hopes to accomplish the following goals in the current decade:
- Raise awareness of the growing burden of MSD on society: This will be done through translation of the epidemiological global burden of RMSD into financial costs. This will be further communicated to the national decision makers in different countries, who will then devise methods and means to reduce the RMSD burden to society by shifting indirect to direct health care costs.
- Promote the prevention of RMSD and empower patients through education campaigns:
The BJD national action networks (NAN), in close liaison with the national government health authorities and agencies, and the International WHO–BJD Steering Group, will design public awareness and education campaigns. Patients must be empowered to participate in their own health care.
- Advanced research in the prevention, diagnosis and treatment of RMSD, including rheumatic disorders:
It is expected to triple the existing research funding during the decade.
- Improve diagnosis and treatment of RMSD.
The specific goal would be to influence the medical schools and colleges to impart a better and practical training program, of at least six months, to undergraduates. The diagnostic and treatment skills of the GP need to be improved. Similar proposals will be made for other medical groups engaged in the care of RMSD.
Finally, it is hoped that at the end of the current decade there will be 25 per cent reduction in an expected increase in joint destruction by arthritis, osteoporotic fractures, severely injured people, and indirect health cost for spinal disorders.
The BJD National Action Network (NAN) For India
In close liaison with the International Steering Committee, a NAN committee for India has been proposed and accepted. The committee will consist of:
Prof T K Shanmugasunderam (chairman), Prof D Mohan (coordinator),
Dr Arvind Chopra (secretary), Dr A Mittal, Dr S Goyal.
The committee will initiate a dialogue with Government health authorities and other concerned national associations and agencies to promote the activities of the WHO–BJD in India. It will co–opt experts from related medical disciplines from different parts of India. The initial attempt will be to create a national data base on some of the RMSD, and encourage data collection through well organized epidemiologically driven multicentric studies. In all earnest and at the earliest, the Indian NAN committee will try to obtain an official endorsement of the WHO BJD project by the Government of India.