The Epidemiology Study Of Rheumatic Diseases In Tucheng Village, Chenghai District, Shantou, China

Objective To evaluate the change of the prevalence and the clinical features of thefrequently seen rheumatic disorders in the rural after the economic reform and openingup to the outside world, and the prevalence of soft tissue rheumatism (STR) in Shantouarea. Thus to investigate the associated risk factors of special diseases, and to improvethe level of diagnosis, treatment, and prevention measures.Methods The working team included 6 primary healthy workers and 3 rheumatologists.Modified ILAR-China Core Questionnaire, APLAR-COPCORD Core Questionnaire forIdentification of Soft Tissue Rheumatism, procedure of the Community OrientedProgram for Control of Rheumatic Disorders (COPCORD) were implemented. Thesubjects were interviewed house by house (PhaseⅠ,Ⅱ). Positive respondents wereexamined simultaneously by rheumatologists (PhaseⅢ). X-ray films and laboratoryexamination were arranged for the suspected cases in PhaseⅣ. The films were read by2 radiologists blindly and independently, and arrived at a consensus opinion at last.Suspected cases were recalled after completion of the survey and examined byrheumatologists to ensure international comparability of the diagnosis. All the data wereanalyzed with SPSS 11.5 for Windows. The prevalence rate was standardized with thenationwide census in year 2000 as standard group. The ACR criteria for osteoarthritis,rheumatoid arthritis, ankylosing spondylitis, gout, systemic lupus erythematosus, and theAmor's criteria for spondyloarthropathies, The associated risk factors of special diseases,such as age, sex, body mass index (BMI), Waist-to-hip ratio (WHR) et al., were includedin logistic regression model for further analysis.Results A total of 2350 subjects (1144 men, 1206 women) aged≥16 years were recruited in this study, made a response rate of 96.45%. The overall age and sexadjusted prevalence of rheumatic pain was 18.72% (479/2350), being significantly higheramong women (21.84%) than that in men (15.20%). The prevalence of low back painwas the highest, followed by knee pain and neck pain, with the prevalence of 12.81%,5.66% and 5.53% respectively. The prevalence of rheumatic pain at any individual sitewas significantly higher in women than that in men. Symptomatic osteoarthritis wasfound to be the most common rheumatic disorder, followed by soft tissue rheumatism,ankylosing spondylitis, gout and rheumatoid arthritis, with a prevalence of 10.68%,5.74%, 0.30%, 0.26%, and 0.21%, respectively. The prevalence rate of osteoarthritiswas significantly higher in women than that in men (12.44% vs 8.83%). The prevalenceof lumbar osteoarthritis was the highest among the subsets of osteoarthritis, followed byknee osteoarthritis and cervical osteoarthritis (7.87%, 3.06%, and 2.38% respectively).The prevalence of osteoarthritis in Shantou area was significantly lower than that in othercities such as Beijing, Taiyuan and Shanghai, et al. Logistic regression revealed that age,female, BMI and occupation were significantly associated with osteoarthritis. Lateralepicondylitis (tennis elbow), rotator cuff (shoulder) tendinitis, metatarsalgia, digital flexortenosynovitis, and plantar fasciitis were the commonly seen soft tissue rheumatism, witha prevalence of 0.98%, 0.89%, 0.72%,0.68% and 0.68% respectively. Fibromyalgia israre, and only 2 cases were found. Logistic regression analysis showed a significantpositive association of age, female sex and occupation with STR. Of the 22 cases(0.94%) of spondyloarthropathies, 6 (0.26%) were ankylosing spondylitis comprising 5males and 1 female, and 16 (0.68%) were undifferentiated spondyloarthropathies withthe ratio of male: female be 2.2:1. Conclusion Symptomatic osteoarthritis is found to be the most common rheumaticdisorder in Tucheng village, Chenghai District, Shantou area, followed by soft tissuerheumatism, gout, ankylosing spondylitis, and rheumatoid arthritis. Low back pain, kneepain, and neck pain were the most commonly seen rheumatism, and were moreprevalent in female than in male. Lumbar osteoarthritis, knee osteoarthritis, and cervicalosteoarthritis were the major subsets of osteoarthritis. Lateral epicondylitis (tenniselbow), rotator cuff (shoulder) tendinitis, metatarsalgia, digital flexor tenosynovitis, andplantar fasciitis were the most commonly seen soft tissue rheumatism, and fibromyalgiais rare. Geography, aging, overweight (BMI≥24) and occupation might be theassociated risk factors of osteoarthritis. And aging, female sex and occupation alsomight be the associated risk factors of soft tissue rheumatism. Primary health care andintegrate control of common rheumatic diseases should be enhanced. Prevention ofosteoarthritis should be initiated before the middle-aged. Weight control and obesityavoiding are important in preventing knee osteoarthritis.