Rheumatology in the third world

Article Abstract:

Communicable diseases are the major health problem in many countries of the third world, and these same countries are hindered by inadequate health budgets and financial crises. The question of whether the meager resources for medicine should be split so as to provide rheumatology services is answered in the affirmative in this article. Rheumatological care and research in developing countries will not only benefit these countries, but will advance understanding of rheumatology worldwide. The extent of rheumatic disease in the third world is greater than previously thought and may be increasing. Response to a newly established rheumatology clinic in West Africa was much greater than expected. Because of the low availability of doctors, health care workers must be trained in prevention and control of rheumatic diseases. The populations must be evaluated in order to establish the extent of the problem, determine health priorities, and monitor effectiveness of treatment and other interventions. Epidemiological research in the third world should be useful in identifying risk factors for some rheumatic diseases. This information can be used to improve medical care as well as increase understanding of the diseases. There are distinctive worldwide prevalence patterns for most of the rheumatic diseases, including osteoarthritis, ankylosing spondylitis, systemic lupus erythematosus, and rheumatoid arthritis, and these are described. Thus the third world does not share a single common problem, but rather each country has its particular needs. Finally, there is a lack of trained rheumatologists in the third world. Besides encouraging and training allied health care professionals, professional exchanges and collaboration on research between developed and developing countries is essential. The World Health Organization and similar groups are needed in such interactions. Organizations of rheumatologists in third world are slowly organizing. Much more work in the area of rheumatology is needed before the goal of health for all by the year 2000 is met. (Consumer Summary produced by Reliance Medical Information, Inc.)

International aspects, Developing countries, editorial

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The disabled living center: its relevance to rheumatology

Article Abstract:

A disabled living center is a resource center for persons with various physical and sensory disabilities, such as limited mobility, grasp and reach, and visual impairment. The function of the disabled living center is to give expert help to individual disabled people, their caregivers, and professionals consulting the disabled; and to be a center for teaching and information. Studies show that arthritis, the inflammation of the joints, is the most important disease group leading to disability. The disabled living center provides information about equipment and clothing that may alleviate problems resulting from the loss of mobility that accompany arthritis. Among health care professionals, occupational therapists commonly use disabled living centers, whereas doctors are less likely to use these centers. The centers often provide seminars, workshops, displays of new equipment, regular teaching sessions, small, informal courses for general practitioners, and tours of the center. Although professionals may be charged a small fee for the teaching programs provided by the center, individual patients are never charged. A survey of persons who used the disabled living center showed that 40 percent of inquiries were from medical/paramedical personnel; 23 percent from caregivers; eight percent from self-referrals; and 31 percent from education departments, manufacturers, retailers, and community services. Most patients coming to these centers had moderate or severe disabilities. Many had arthritis, were over 60 years old, and came from less than 15 miles away. Most problems presented by patients were solved by the center. A recent report showed that the majority of successful disabled living centers were independent charities with business status. Centers supported by large organizations and funding from several sources were financially secure. Rheumatologists, or physicians who specialize in the care of rheumatic diseases, and other health care professionals should become more involved in establishing disabled living centers. (Consumer Summary produced by Reliance Medical Information, Inc.)

United Kingdom, Services, Disabled persons, Physically disabled persons, Great Britain

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Pattern of osteoarthritis in a West African teaching hospital

Article Abstract:

Osteoarthritis is one of the most common rheumatic diseases, but its cause is not well understood. The pattern of osteoarthritis development and its prevalence vary among world populations, and it is likely that study of these variations may improve understanding of the disease. The rheumatic diseases which occur in West African populations have been somewhat different characteristics than those in other world regions. The incidence of osteoarthritis was characterized in this study conducted in a Nigerian teaching hospital, where osteoarthritis was the most prevalent chronic rheumatic disease. Of 140 patients with the disease, 109 were female; a total of 252 joints were affected. The knee joint was most commonly involved, and this may have been related to trauma incurred by a particular posture used by market traders and by women, who must kneel for greeting as well as for prayer. The lower back was also commonly involved, while hip joint disease was quite infrequent. Most commonly, disease was limited to a single joint or site. Heberden's nodes, enlargement of the outermost finger joints, which usually accompany multiple joint involvement, were also quite infrequent, as was involvement of finger joints. Up to 81 percent of patients reported morning stiffness. Further study of osteoarthritis in African populations should help to explain the significance of the observed trends in the occurrence of this disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Demographic aspects, Nigeria, Osteoarthritis

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