Times of India
12 October 2009
by Umesh Isalkar
Pune, India

‘Tobacco a Leading Cause of Rheumatism’
Among the 8,000 people surveyed in Pune city, about 10 per cent complained of one or the other kind of rheumatic pain. The data, which is part of an ongoing study, revealed that most of the people surveyed consumed tobacco in one form or the other. “The study to measure burden of rheumatism on the Indian population at 17 cities/towns shows that at least 10–15 per cent of the population suffers from arthritis or some form of rheumatism. And the use of tobacco has emerged as a leading risk factor for rheumatic pains. This public health issue is yet to be recognised by the Indian medical faculty and community,” said rheumatologist Arvind Chopra.

Chopra has combined his skills with that of the gram panchayat at Bhigwan village, where too 9,000 people were surveyed, to create an exemplary community model of rheumatic disease.

The Bhigwan COPCORD (Community Oriented programme and control of Rheumatic Diseases) programme has completed 13 successful years of providing free of cost arthritis diagnosis and treatment services and acquiring community research data. “Started in 1996 as the maiden Indian programme on arthritis, the programme has covered a population of 9,000 in village Bhigwan and over 45,000 in the neighbouring 187 villages,” said Chopra.

Though initiated in over 19 countries worldwide by the WHO – ILAR (International league of rheumatology) as the arthritis programme primarily targeting rural communities in developing countries, it is only the Bhigwan project that has continued beyond the initial stage of population survey to measure community illness burden, added Chopra.

The WHO used the Bhigwan data to project the rheumatic burden in South East Asia in its seminal technical research publication titled ‘The Burden of Musculoskeletal conditions at the start of the new millennium. Report of a WHO Scientific group, 2003’, added Chopra. Notably, 15 per cent people surveyed in Bhigwan village had complained of rheumatic pain.

The Bhigwan model has been adopted to launch several population–based rheumatic musculoskeletal studies in Jammu, Chennai, Delhi, Kolkata, Pune, Ralegaon Siddhi, Manipur, Bikaner, Patiala, Thiruvananthapuram and Kozikode. Over 35,000 people have already been surveyed, added Chopra.

Almost 2/3 of the patients were suffering from degenerative ailments and soft tissue rheumatism disorders. Inflammatory arthritis is characterised by pain swelling and sometimes crippling deformities was diagnosed in less than 10% of community cases, said Chopra.

“Rheumatoid arthritis and Ankylosing Spondylitis are important disorders in the inflammatory group. Occupational overuse (physical exertion) probably contributed to cases of soft tissue pains,” said Chopra.

Chopra further states that deforming inflammatory arthritis, like rheumatoid arthritis, which are a major treatment challenge and attract the maximum medical attention in hospitals and medical colleges, actually afflict less than 10 percent of the community patients suffering from rheumatism.