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Background: Rheumatic and musculoskeletal disorders (RMDs) affect billions of people globally, with rising prevalence. RMDs cause significant disability and have a negative impact on health-related quality of life (HRQoL), mental well-being, comorbidities and mortality [1]. In response to extensive RMD epidemiological research in developed countries, the ‘Community Oriented Program for Control of Rheumatic Diseases’ (COPCORD) initiative was launched in developing countries, by the World Health Organization and International League of Association for Rheumatology. The ultimate goal is to improve prevention, screening, management and recognition of RMDs in developing countries by assessing the prevalence, incidence, risk factors and HRQoL of RMDs. A COPCORD research study consists of three stages: in stage one, local healthcare workers conduct house-to-house surveys to identify people with musculoskeletal (MSK) complaints and to describe disease disability (phases I and II), followed by medical evaluations to estimate RMDs prevalences (phase III). In stage two, risk factors associated with RMDs are identified, health education is improved, leading to diagnostic and therapeutic changes in stage three [2].
Objectives: To estimate the prevalence of RMDs in two urban areas of Suriname, Paramaribo and Wanica, in phase III of the COPCORD Suriname Study.
Methods: Of the 2221 participants from phase I and II [3], 1131 participants (who reported complaints in the initial enquiry) were referred for medical assessment in phase III. Demographic data and information on MSK symptoms, systemic symptoms and medical history was collected, followed by a clinical examination. If available, imaging and laboratory information was collected. Anonymized data of these phase III consultations was transferred to Belgium and analyzed. If applicable, a RMD diagnosis was given to each participant, based on clinical classification criteria and medical knowledge. A difference was made between a definite diagnosis, which the participant was aware of prior to the study, and a probable diagnosis. Descriptive statistics and prevalence of several RMDs were calculated. Chi-square tests or Fisher’s exact tests were applied to assess differences in prevalences across gender. A p-value < 0,05 was considered as significant.
Results: Phase III included 1131 participants, of which 734 females and 397 males, with a median age of 45 years. The three predominant ethnicities were Hindustani (32%), Creoles (25%) and mixed (16%). Pain was the most frequently self-reported symptom (>90%), followed by joint swelling and sensory disorders. All symptoms were more frequently reported by females, except for restricted range of motion and joint redness. Complaints were mostly of chronic duration (>3 months) (51%) versus acute, of oligoarticular distribution (38%) versus mono- or polyarticular, and of non-specific pain pattern (36%). The most prevalent inflammatory MSK disorder was gout (2%), showing a clear male predominance (p<0,001), followed by undifferentiated arthritis (1%), mostly of the knee joint (n = 8). Prevalence of other rheumatic findings, including rheumatoid arthritis, Paget’s disease, axial spondyloarthritis, psoriatic arthritis, and polymyalgia rheumatica) was all less than 1%. There were no reported cases of systemic lupus erythematosus, vasculitis and systemic sclerosis. Mechanical RMDs or pain patterns were more commonly reported, including mechanical back pain (51%), mechanical arthralgia/myalgia (28%), and definite osteoarthritis (OA) (10%),. Other prevalent RMDs were tendinopathies and subarticular problems (12%), mostly represented by rotator cuff pathology (5%). Notably, post-infectious arthralgia (3%) was predominantly seen after Chikungunya infection, while post-traumatic iatrogenic arthralgias affected 9% of the phase III population. Herniated nucleus pulposus (7%) and carpal tunnel syndrome (3%) were the most prevalent neurological findings.
Conclusion: The burden of RMDs should not be underestimated in Suriname, with a prevalence of gout ranked the highest and a prevalence of OA ranked in the middle among diverse South American COPCORD studies. Specifically, gout (2%), subarticular pathology (12%), back pain (51%) and OA (10%) should be acknowledged as prevalent and severe conditions. Stage two and three must be organized to further investigate underlying risk factors and fundamentally reshape education and health policy regarding RMDs. Efforts should be made to engage general practitioners, rheumatologists, medical students and policy makers to undertake epidemiological research. Future research should adopt updated clinical criteria, digitalize consultation forms with alerts for missing data, and collaborate with hospitals for imaging and laboratory data to improve the COPCORD study quality. This study is considered a crucial first step in a long-term effort to reduce the disease burden of RMDs in Suriname.
REFERENCES: [1] Safiri S, Kolahi AA, Cross M, Hill C, Smith E, Carson-Chahhoud K, et al. Prevalence, Deaths, and Disability-Adjusted Life Years Due to Musculoskeletal Disorders for 195 Countries and Territories 1990-2017. Arthritis Rheumatol. 2021;73(4):702-14.
[2] Diseases CfR.
[3] Ho-A-Tham N, Vanlandewijck Y, de Donder L, Wittoek R, Ting-A-Kee B, Basantram R, Dankaerts W. Prevalence of musculoskeletal complaints in urban communities in multi-ethnic Suriname: a cross-sectional study with the COPCORD methodology (stage 1, phase 1 and 2). Clin Rheumatol. 2020 Apr;39(4):1065-1075. doi: 10.1007/s10067-019-04842-5. Epub 2019 Dec 4. Erratum in: Clin Rheumatol. 2020 Apr;39(4):1377-1378. doi: 10.1007/s10067-020-04989-6. PMID: 31802349.
Acknowledgements: NIL.
Disclosure of Interests: None declared.
© The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license (