Rheumatic disease in an Australian Aboriginal community in North Queensland, Australia. A WHO-ILAR COPCORD survey.

OBJECTIVE: To estimate prevalences of rheumatic diseases in Aboriginal Australians. METHODS: The methodology of the Community Oriented Program for the Control of Rheumatic Diseases (COPCORD) was followed. Everyone aged 15 years or older in Yarrabah, North Queensland, was invited to complete a COPCORD Core Questionnaire. Aboriginal health workers carried out a house-to-house survey during January 2002. People reporting current musculoskeletal symptoms and 56 others (controls) were examined at the community health center. RESULTS: Eighty percent of the target population was covered during the survey. Eight hundred and forty-seven questionnaires were completed (47% men) and 135 people refused, a response of 86%. Rheumatic symptoms within the previous 7 days were reported by 33% and past symptoms by 22%. The most common sites of current pain were low back (12.5%), knee (11.2%), and shoulder (8.9%). Sixty-seven people (7.7%) said activities were limited by their symptoms. Two hundred and sixty-three people were examined, and the most common diagnoses were soft tissue pain (point prevalence 7.4%), osteoarthritis (5.5%), and low back pain (4.3%). The cumulative prevalence of gout was 7.0% in men and 0.9% in women over the age of 15 years. The relative risk of gout associated with drinking regularly was 2.5, and with body mass index > 25 was 3.3. No rheumatoid arthritis or systemic lupus erythematosus cases were identified, but there were 4 cases of psoriatic arthritis (point prevalence 0.5%). CONCLUSION: This is the first unselected population study of rheumatic diseases in Australian Aboriginals. There was a high prevalence of gout among men, with modifiable factors of weight and alcohol identified.

Outcome after 40 years with rheumatoid arthritis: a prospective study of function, disease activity, and mortality.

In an inception cohort of 100 patients with rheumatoid arthritis (RA) we studied course and outcome after 40 years, regarding function, disease activity, cause and age of death, and prognostic factors. Function, joint count, erythrocyte sedimentation rate (ESR), hemoglobin (Hb), rheumatoid factor (RF), and the number of orthopedic operations were measured in 100 consecutive referrals between 1957 and 1963 with either definite or classical RA at one year after onset of symptoms. Subjects have been followed for a mean of 40 years, or until death. In May 1999, 84 subjects had died. Of the 16 survivors, 8 (50%) were severely disabled from RA while 5 (31%) had normal function. The mean joint score had gradually increased over 40 years. Death was directly attributable to RA in 13, while RA or its treatment contributed to death in 11 subjects. In the other 60 deceased subjects, cardiovascular causes accounted for 28 deaths (33% of total deaths). Features at one year that were associated with mortality up to 40 years after onset by regression analysis were: older age (p < 0.0001), lower Hb (p = 0.0461), and worse function (p < 0.0001). The standardized mortality ratio of the cohort at 40 years was 2.13 (confidence interval 1.26-3.60), and median survival was reduced by 10 years for men and 11 years for women compared to the general population. In conclusion, RA is a progressive disease impairing function up to 40 years after onset, with shortened life span. The leading cause of death was cardiovascular disease.