Pattern of Musculoskeletal Disorders among Diabetic Patients Attending The Department of Physical Medicine and Rehabilitation in a Tertiary Care Hospital

Background: Disorders of musculo-skeletal (MSK) system are very common scenario watched in diabetic patients and is a major cause of morbidity, mortality and hospitalization. Objective: The present study to see the pattern of MSK disorders among the Bangladeshi diabetic patients. Materials & Methods: This is a cross-sectional study carried out at the department of Physical Medicine and Rehabilitation in Thengamara Mohila Sabuj Sangha (TMSS) Medical College Hospital, Bogura for the period of one year from February 2019 to January 2020. A total of 450 diabetic patients with MSK disorders were included in this study. Results: A total of 450 patients with MSK disorders were studied. Out of them 208 (46%) were males and 242(54%) were females.31.5% were between the age group of 41-50 years and 28.9% was between 51-60years.Majority were housewives (51.2%) followed by cultivator(16.2%).Degenerative joint diseases were more common (31.4%) than inflammatory arthropathies (19.3%).Lumbar and cervical spondylosis constituted about 31.4% of all disorders& 22.7% presented with OA knee whereas 15.6% presented with rheumatoid arthritis. Conclusion: Degenerative disorders of the MSK system are more common than the inflammatory ones amongst the diabetics.Maximum patients were having OA of knee, lumbar spondylosisand soft tissue rheumatism. KYAMC Journal.2021;12(1): 41-43

Spectrum of rheumatologic disorders among patients attending with musculoskeletal symptoms: experience from medicine outpatient department of a tertiary care hospital of Bangladesh

Background: Musculoskeletal conditions are prevalent and their impact is pervasive. They are one of the most common causes of long-term pain; affect hundreds of millions of people around the world; they significantly affect the psychosocial status of the affected people as well as their families and carers. This study was done to evaluate the spectrum of rheumatologic disorders among patients attending at medicine outpatient department (OPD) with musculoskeletal symptoms. Methods: This cross-sectional study was done at OPD of Medicine, BIRDEM General Hospital from January 2014 to June 2017. All patients attending at OPD having musculoskeletal symptoms, who fulfilled criteria of definite rheumatologic disease and known rheumatologic disorders were consecutively and purposively included in this study. Results: Total patients were 495 with female predominance (71.31%). Mean age was 48.6 years (range 18-76 years). Among the study population majority had inflammatory joint and spine diseases (69.69%);then degenerative joint and spine diseases (22.02%), connective tissue diseases (2.22).Two-thirds of the patients had rheumatoid arthritis (RA) (76.23%) among inflammatory joint and spine diseases, then ankylosing spondylitis (AS) (13.33%).Regarding connective tissue disease, systemic lupus erythematosus (SLE) was more frequent (45.5%). Among soft tissue rheumatism and metabolic bone disease, all study subjects had fibromyalgia (FM) and osteoporosis respectively. Rheumatoid factor was positive among two-thirds and anti-CCP antibody in twofifths of RA cases, HLA-B27 was positive in 4.3% of AS, antineuclear antibody (ANA) and anti-ds DNA were positive in all SLE patients. Common co-morbidities were diebetes (41.4%), ischaemic heart disease (20.6%) and hypertension (19.1%). Conclusion: RA was the most common inflammatory joint disease. Degenerative diseases were the second most common condition. Common connective tissue disease was SLE. Birdem Med J 2021; 11(2): 116-120

Prevalence of musculoskeletal conditions and related disabilities in Bangladeshi adults: a cross-sectional national survey

Background Nationally representative data on burden of musculoskeletal conditions (MSK) in Bangladesh are not available. The objective of this study was to determine the prevalence of MSK conditions and related disabilities in the adult population of Bangladesh. Methods A total of 2000 individuals aged 18 years or older were targeted from 20 primary sampling units (urban and rural) of all former seven divisions of Bangladesh in 2015. Structured interviews were done using the modified Community Oriented Program for Control of Rheumatic Disorders questionnaire to detect positive respondents. Standard criteria were used for diagnosing MSK conditions by rheumatology residents. In case of uncertainty, opinion was taken from senior rheumatologists. A Bangla version of the Health Assessment Questionnaire was used to determine disability. Results A total of 1843 (92.1%) participated. Among them, 892 men and 951 women participated from rural (n = 716) and urban (n = 1127) areas. Their mean age was 40.5 (standard deviation 14.7) years. Almost a third did not have any formal schooling. Overall, 30.4% (95% confidence interval, 28.3–32.5) had MSK conditions. Low back pain (18.6%, 16.9–20.5), knee osteoarthritis (7.3%, 6.1–8.5) and soft tissue rheumatism 3.8% (2.9–4.7) were the three top-ranking MSK conditions. Rheumatoid arthritis (1.6%, 1.0–2.1), spondyloarthritis (1.2%, 7–1.8) and adhesive capsulitis (1.4%, 0.9–1.9) were relatively uncommon. Among those who had MSK conditions, 24.8% (21.3–28.6) had some degree of disability. Of them, 24.4% (21.0–28.1) had history of work loss during last 12 months. Conclusions The high burden of MSK conditions and related disabilities in Bangladesh warrants greater attention of the health system. Further studies are needed to estimate the impact of this group of conditions particularly addressing related disabilities and loss of work.

Prevalence of musculoskeletal conditions and related disabilities in Bangladeshi adults: a cross-sectional national survey

Background: Nationally representative data on burden of musculoskeletal conditions (MSK) in Bangladesh are not available. The objective of this study was to determine the prevalence of MSK conditions and related disabilities in the adult population of Bangladesh.Methods: A total of 2000 individuals aged 18 years or older were targeted from 20 primary sampling units (urban and rural) of all former seven divisions of Bangladesh in 2015. Structured interviews were done using the modified Community Oriented Program for Control of Rheumatic Disorders questionnaire to detect positive respondents. Standard criteria were used for diagnosing MSK conditions by rheumatology residents. In case of uncertainty, opinion was taken from senior rheumatologists. A Bangla version of the Health Assessment Questionnaire was used to determine disability.Results: A total of 1843 (92.1%) participated. Among them, 892 men and 951 women participated from rural (n=716) and urban (n=1127) areas. Their mean age was 40.5 (standard deviation 14.7) years. Almost a third did not have any formal schooling. Overall, 30.4% (95% confidence interval, 28.3-32.5) had MSK conditions. Low back pain (18.6%, 16.9-20.5), knee osteoarthritis (7.3%, 6.1-8.5) and soft tissue rheumatism 3.8% (2.9-4.7) were the three top-ranking MSK conditions. Rheumatoid arthritis (1.6%, 1.0-2.1), spondyloarthritis (1.2%, 7-1.8) and adhesive capsulitis (1.4%, 0.9-1.9) were relatively uncommon. Among those who had MSK conditions, 24.8% (21.3-28.6) had some degree of disability. Of them, 24.4% (21.0-28.1) had history of work loss during last 12 months. Conclusions: The high burden of MSK conditions and related disabilities in Bangladesh warrants greater attention of the health system. Further studies are needed to estimate the impact of this group of conditions particularly addressing related disabilities and loss of work.

Prevalence of musculoskeletal conditions and related disabilities in Bangladeshi adults: a cross-sectional national survey

Background: Nationally representative data on burden of musculoskeletal conditions (MSK) in Bangladesh are not available. The objective of this study was to determine the prevalence of MSK conditions and related disabilities in the adult population of Bangladesh.Methods: A total of 2000 individuals aged 18 years or older were targeted from 20 primary sampling units (urban and rural) of all former seven divisions of Bangladesh in 2015. Structured interviews were done using the modified Community Oriented Program for Control of Rheumatic Disorders questionnaire to detect positive respondents. Standard criteria were used for diagnosing MSK conditions by rheumatology residents. In case of uncertainty, opinion was taken from senior rheumatologists. A Bangla version of the Health Assessment Questionnaire was used to determine disability.Results: A total of 1843 (92.1%) participated. Among them, 892 men and 951 women participated from rural (n=716) and urban (n=1127) areas. Their mean age was 40.5 (standard deviation 14.7) years. Almost a third did not have any formal schooling. Overall, 30.4% (95% confidence interval, 28.3-32.5) had MSK conditions. Low back pain (18.6%, 16.9-20.5), knee osteoarthritis (7.3%, 6.1-8.5) and soft tissue rheumatism 3.8% (2.9-4.7) were the three top-ranking MSK conditions. Rheumatoid arthritis (1.6%, 1.0-2.1), spondyloarthritis (1.2%, 7-1.8) and adhesive capsulitis (1.4%, 0.9-1.9) were relatively uncommon. Among those who had MSK conditions, 24.8% (21.3-28.6) had some degree of disability. Of them, 24.4% (21.0-28.1) had history of work loss during last 12 months. Conclusions: The high burden of MSK conditions and related disabilities in Bangladesh warrants greater attention of the health system. Further studies are needed to estimate the impact of this group of conditions particularly addressing related disabilities and loss of work.

Prevalence of musculoskeletal conditions and related disabilities in Bangladeshi adults: a cross-sectional national survey

Background: The objective of this study was to determine the prevalence of musculoskeletal (MSK) conditions and related disabilities in the adult population of Bangladesh because was no nationally representative data. Methods: A total of 2000 individuals aged 18 years or older were targeted where 1843 (92.1%) participated from 20 primary sampling units (urban and rural) of all former seven divisions of Bangladesh in 2015. Structured interviews were done using the modified Community Oriented Program for Control of Rheumatic Disorders questionnaire to detect positive respondents. Standard criteria were used for diagnosing MSK conditions by rheumatology residents. In case of uncertainty, opinion was taken from senior rheumatologists. A Bangla version of the Health Assessment Questionnaire was used to determine disability. Results: Among the respondents, 892 men and 951 women participated from rural (n=716) and urban (n=1127) areas. Their mean age was 40.5 (standard deviation 14.7) years. Almost a third did not have any formal schooling. Overall, 30.4% (95% confidence interval, 28.3-32.5) had MSK conditions. Low back pain (18.6%, 16.9-20.5), knee osteoarthritis (7.3%, 6.1-8.5) and soft tissue rheumatism 3.8% (2.9-4.7) were the three top-ranking MSK conditions. Rheumatoid arthritis (1.6%, 1.0-2.1), spondyloarthritis (1.2%, 7-1.8) and frozen shoulder (1.4%, 0.9-1.9) were relatively uncommon. Among those who had rheumatic disorders, 24.8% (21.3-28.6) had some degree of disability. Of them, 24.4% (21.0-28.1) had history of work loss during last 12 months. Being overweight, having history of physical trauma and diabetes mellitus, age and female sex were positively but education was negatively associated with MSK disorders. Conclusions: The high burden of MSK conditions and related disabilities in Bangladesh is high. Further studies are needed to estimate the impact of this group of disorders particularly addressing YLD, quality of life and economic consequences.

A Qualitative Study of Patients’ Beliefs and Perception on Medicinal Properties of Natural Hot Spring Bath for Musculoskeletal Problems

Natural therapy modalities such as thermal therapy and balneotherapy are commonly being practiced for the management of chronic aches and pain all over the world. Nepal has many such natural hot water springs among which few are famous for therapeutic purposes. Thousands of people with some musculoskeletal problem visit those places in the hope of getting rid of their problems. This study aimed to understand their belief in such therapies, expectations, and satisfaction after treatment along with their knowledge of the safety of hot spring water bath. Among 126 participants interviewed, 31% had inflammatory arthritis, followed by degenerative disorders in 29.4% and soft-tissue rheumatism in 12.7%. Around three-quarters believed that hot spring water has natural healing power and thus can improve their pain. Many even believed that water in natural springs is devoid of any chemicals. So, it is a safe treatment option. Regarding the expectation of cure, they had mixed opinions. Naïve participants hoped they might find a permanent cure in thermal baths. However, repeated visitors said that the effect usually lasted for a few months and they have to visit there regularly. Almost two-thirds of people thought that such natural treatment does not have any side effects. Few stated that they had faced certain problems after the treatment. The water tested from the study site showed that it contained a higher amount of chlorine and sulfate in comparison to other hot water springs in Nepal. The minerals present in water might be a cause of temporary relief of pain. Also, outbreaks of infection from common spring baths have to be considered as such cases have been reported in the past. In conclusion, the medicinal benefits of such natural hot water springs have to be studied further and awareness regarding safety should be given to the people seeking treatment.

AB1227 PREVALENCE OF RHEUMATIC MUSCULOSKELETAL DISORDERS IN A RURAL AREA OF UPPER EGYPT: WHO-ILAR COPCORD BASED COMMUNITY STUDY

Background:Rheumatic musculoskeletal disorders (RMSDs) are a common cause of long term pain and physical disability. In developed countries, RMSDS are a major cause of absence from work and thus have a big financial burden on the country economic status. Several studies have been published the incidence and prevalence of RMSDs in different world countries and found to be widely variable. Estimation of the extend of the problem of RMSDs in developing world, especially in rural economies will help better understanding of the risk factors that contribute to the initiation and progression of these diseases and help the health care authorities to provide proper health program services in these areas to reduce the physical and financial burden of RMSDs (Bagher et al., 2011; Majumdar et al., 2015 and Usenbo, et al., 2015).Objectives:To estimate the prevalence rate of RMSDs in a rural population in Upper Egypt.Methods:A cross-sectional based study was carried out and included 3988 subjects of population (2013 females and 1975 males). Mean age of patients was (46.89±15.25ys). They proceeded 4 phases of World Health Organization/International League of Associations for Rheumatology community-oriented program for control of rheumatic diseases survey questionnaire WHO-ILAR Community Oriented Program for screening of rheumatic diseases. Modified Health Assessment Questionnaire (HAQ) was used to assess the disability severity. Individuals suspected to have any rheumatic diseases were subjected to full clinical examination, laboratory and radiological investigations to reach a final diagnosis. They were classified according to appropriate criteria of diagnosis of diseases.Results:A prevalence rate of RMSDs was 16.22%, more prevalence in females (10.38% vs. 5.84% for males, P=0.000). The mean age of patients with RRMSDSs were older (46.89±15.25 yrs) than healthy individuals (29.56±18.95 yrs) (P=0.0001) and with increasing age (≥45-≤ 55 yrs).The identified RMSDs were OA (8.5%), Soft tissue rheumatism (STR) (6.57%), spinal disorders (SD) (6.47%), fibromyalgia (FM) (0.60%), RA (0.30%), arthralgia (0.18%), SPAs (0.15%), Gout(0.6%), Pseudogout (0.08%), SLE (0.5%), JIA(0.03) and MCTD (0.03%). The prevalence rates for the majority of RRMSDSs were higher in females and with increasing age. About two thirds of the patients had grade II disability.Conclusion:The prevalence rate of RMSDs in a rural population ≥15years in Upper Egypt has been estimated to be 16.22%.The most prevalent RMSDs are OA, STR and SD causing the greatest burden of the disease. The predictive risk of RMSDs has to be assessed in future studies.References:[1]Majumdar A, Kumar SG, Nair D, Sujiv A. Musculoskeletal complaints and predictors of musculoskeletal pain among adults in rural puducherry. Indian J Palliat Care. 2015; 21(1):121-123.[2]Usenbo A, Kramer V, Young T, Musekiwa A. Prevalence of Arthritis in Africa: A Systematic Review and Meta-Analysis. PLoS One. 2015; 10 (8):e0133858.[3]Bagher OM, Golbarg M, Hossein S. Pattern of rheumatic diseases in two outpatient clinics in Iran: similarities with some different features. Indian J Med Sci. 2011; 65(1):7-17.Disclosure of Interests:None declared

Prevalence of Rheumatic Disorders and Related Disabilities in Bangladeshi Adults: A Cross-Sectional National Survey

Objectives: To determine the prevalence of rheumatic disorders and related disabilities in the adult population of Bangladesh.Methods: A total of 2000 individuals aged 18 years or older were targeted where 1843 (92.1%) participated from 20 primary sampling units (urban and rural) of all former seven divisions of Bangladesh in 2015. Modified Community Oriented Program for Control of Rheumatic Disorders questionnaire was used to detect positive respondents. Standard criteria were used for diagnosing rheumatic disorders by residents of rheumatology and expert rheumatologists. A Bangla version of the Health Assessment Questionnaire was used to determine disability.Results: Among the respondents, 892 men and 951 women participated from rural (n=716) and urban (n=1127) areas. Their mean age was 40.5 (standard deviation 14.7) years. Almost a third did not have any formal schooling. Overall, 30.4% (95% confidence interval, 28.3-32.5) had rheumatic disorders. Nonspecific low back pain (12.7%, 11.2-14.2) and knee osteoarthritis (7.3%, 6.1-8.5) were the two top-ranking rheumatic disorders followed by lumbar spondylosis 6.0% (4.9-7.1) and soft tissue rheumatism 3.8% (2.9-4.7). Rheumatoid arthritis (1.6%, 1.0-2.1), spondyloarthritis (1.2%, 7-1.8) and frozen shoulder (1.4%, 0.9-1.9) are relatively uncommon. Among those who had rheumatic disorders, 24.8% (21.3-28.6) had some degree of disability. Of them, 24.4% (21.0-28.1) had history of work loss during last 12 months. Being overweight, having history of physical trauma and diabetes mellitus, age and female sex were positively but education was negatively associated with rheumatic disorders. Conclusions: The high burden of rheumatic disorders and related disabilities in Bangladesh warrants public health and clinical interventions.Highlights1. This is the first national level study using primary sampling units of Bangladesh Bureau of Statistics engaging rheumatology residents for data collection. The diagnoses have been validated or confirmed by rheumatologists in the field in partnership with divisional level medical college hospitals.2. Prevalence of rheumatological disorders (low back pain, knee osteoarthritis and lumbar spondylosis are commonly prevalent), associated pain, disability (as determined using B-HAQ) and work loss are so common that warrants public health and clinical intervention. Name of department(s) and institution(s) to which the work should be attributed:Department of Rheumatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, BangladeshThe source(s) of support in the form of grants or industrial support:This work was supported by World Health Organization, Bangladesh (Agreement Reference: SEBAN140895).