India is home to the world's second largest population. Rheumatology is an emerging specialty in India. We reviewed organization, epidemiology and training facilities for Rheumatology in India. Also, we also looked at publications in the field of rheumatology from India from over the past six years using Scopus and Medline databases. Despite rheumatologic disorders affecting 6%-24% of the population, rheumatology in India is still in its infancy. Till recently, there were as few as two centers in the country training less than five fellows per year. However, acute shortage of specialists and increasing patient numbers led to heightened awareness regarding the need to train rheumatologists. Subsequently, six new centers have now started 3-year training programs in rheumatology. The epidemiology of rheumatic diseases in India is being actively studies under the Community Oriented Programme for Control of Rheumatic Diseases (COPCORD) initiative. The most number of publications on rheumatic diseases from India are on rheumatoid arthritis, lupus and osteoporosis, many of which have been widely cited. Major collaborators worldwide are USA, UK and France, whereas those from Asia are Japan, Saudi Arabia and Singapore. The Indian Rheumatology Association (IRA) is the national organization of rheumatologists. The flagship publication of the IRA, the Indian Journal of Rheumatology, is indexed in Scopus and Embase. To conclude, rheumatology in India is an actively expanding and productive field with significant contributions to world literature. There is a need to train more personnel in the subject in India.
Databases, Factual ; Humans ; India ; Publishing ; Rheumatic Diseases/*epidemiology/pathology ; Rheumatology/education ; Societies, Medical/organization & administration

PURPOSE: The purpose of this study was to assess the characteristics of the user of complementary?alternative therapies(CAT) and to identify the important predictive factors associated with them. METHOD: This study included 142 patients attending outpatient rheumatology clinics of D Hospital in Busan between July and August in 2001. The multiple logistic regression model was developed to estimate the likelihood of user or nonuser of CAT. RESULT: The duration of illness and chance score of health locus of control were found to be significant factors through the estimated coefficients of using CAT. Duration of illness is longer and chance score of health locus of control is higher in patients who have used CAT in past than that of nonuser. When the model performance was evaluated by comparing the observed outcome with predicted outcome, the model correctly identified 95% of user of CAT and 31% of nonuser. CONCLUSION: In this survey, duration of illness and chance score of health locus of control are found to be significant factors in predicting utilization of CAT. Nurses who care for rheumatoid arthritis patients should take consideration into health locus of control in planning health education programs.
Animals ; Arthritis, Rheumatoid* ; Busan ; Cats ; Complementary Therapies* ; Health Education ; Humans ; Internal-External Control ; Logistic Models ; Morinda ; Outpatients ; Rheumatology

OBJECTIVES: To assess the prevalence of knee osteoarthritis through proper diagnosis in a rural community and to elucidate the relevant factors of this health problem in order to develop educational methods for the prevention of female knee osteoarthritis as well to provide basic data for prospective research. METHODS: Over a period of three months starting from August, 2000, 432 women over the age of 40 and living in a rural area were selected by a multistage cluster sampling method in order to investigate the prevalence of knee osteoarthritis and the related factors. The study utilized interviews and radiological examination. The criteria of knee osteoarthritis used was the American College of Rheumatology classification criteria for osteoarthritis of the knee(1995). RESULTS: The adjusted prevalence of knee osteoarthritis among the subjects was 55.0%, and multiple logistic regression analysis showed that the odds ratio(OR) of knee osteoarthritis among subjects 50-59 years of age and subjects older than 60 years of age as compared to subjects 40-49 years of age were 2.43(95% CI: 1.30-4.70) and 4.40(95% CI: 2.47-7.83), respectively. The OR of knee osteoarthritis among factory workers or farmers as compared to others was 1.79(95% CI: 1.03-3.12). The OR of knee osteoarthritis among subjects who had a family history and subjects who had knee injury or surgical history against those subjects had neither were 2.56(95% CI: 1.42-4.63) and 4.70(95% CI:1.45-15.19), respectively. The OR of knee osteoarthritis among smokers against non smokers was 0.47(95% CI: 0.22-0.97). CONCLUSIONS: Related factors of knee osteoarthritis included age, occupation, family history, smoking, knee injury and history of surgery. In order to prevent knee osteoarthritis in high risked rural woman, education concerning self-care methods and safety guideline must be provided at the work place by the public and private health sectors. Additionally, these women should be continually encouraged to exercise, including jogging and swimming regularly.
Classification ; Diagnosis ; Education ; Female ; Humans ; Jogging ; Knee Injuries ; Knee* ; Logistic Models ; Occupations ; Osteoarthritis ; Osteoarthritis, Knee* ; Prevalence* ; Rheumatology ; Rural Population ; Self Care ; Smoke ; Smoking ; Swimming ; Workplace

INTRODUCTIONThe objective of this study was to determine if patient information needs are being met and the level of patient satisfaction with rheumatology practitioners in participatory decision-making and thereby indirectly explore whether concordance was achieved.

MATERIALS AND METHODSThe design was a cross-sectional postal questionnaire survey of 420 patients attending outpatient clinics at the Norfolk and Norwich University Hospital who were taking disease modifying anti-rheumatic drugs (DMARDs) or a biological treatment. The population served is ethnically homogeneous and predominantly Caucasian.

RESULTSThe response rate was 76%. Most respondents (79%) had inflammatory arthritis while 66% had rheumatoid arthritis. Seventy-seven per cent of patients reported that the rationale behind commencing treatment was explained and that they were given ample opportunities to ask questions. Eighty-two per cent said they were given an appropriate amount of information. Sixty-four per cent of patients were satisfied with their level of participation in the decision-making process, although a substantial number (25%) said that information from different sources was conflicting. There was no correlation between concern about side effects and patients' perceptions of the effectiveness of medication. Females were more concerned than males about possible side effects; P =0.009, using the Mann-Whitney U test. One third of the patients altered their medication in response to whether their arthritis felt better or worse.

CONCLUSIONThe majority of patients were satisfied that their information needs were met and with the care provided in the practitioner clinic. Participatory decision-making was sub-optimal despite patient satisfaction with the amount of time allocated to meeting their information needs. We found that patients exercise autonomy in managing their arthritis by regulating their medications through an active decision-making process, which is informed by their previous experience of medication, and how well controlled they felt their arthritis was. Research into this decision-making process may hold the key to achieving concordance.

Antirheumatic Agents ; therapeutic use ; Arthritis ; drug therapy ; psychology ; Decision Making ; Female ; Health Care Surveys ; Humans ; Male ; Outpatient Clinics, Hospital ; Pain Measurement ; Patient Education as Topic ; standards ; Patient Participation ; Patient Satisfaction ; statistics & numerical data ; Rheumatology ; standards ; Singapore

Fibromyalgia is a chronic pain syndrome of unknown etiology that is characterized by diffuse musculoskeletal pain, fatigue, sleep disturbance, memory disturbance, and exaggerated tenderness over particular paired locations. Fibromyalgia is found in 2% to 4% of the general population and more common in women, with symptoms usually appearing between 20 and 55 years of age. The diagnostic criteria for fibromyalgia syndrome established in 1990 by the American College of Rheumatology (ACR), includes widespread pain for at least 3 months and point tenderness upon the application of a 4 kg weight at 11 or more of the 18 characteristic tender points. The 2010 ACR preliminary diagnostic criteria have been developed, which are strongly correlated with the 1990 ACR criteria and provide an alternative approach to diagnosis. Patients with fibromyalgia syndrome have lower pain thresholds and experience an altered temporal summation to pain stimuli. The sensitization of pain perception occurs in the dorsal horn of patients with fibromyalgia. However, it is unknown whether sensitization is due to increased pain fiber facilitation, or decreased inhibition. Pregabalin is approved by the United States Food and Drug Administration for the management of fibromyalgia patients. Tricyclic antidepressants, cardiovascular exercise, cognitive behavioral therapy and patient education are also effective in reducing the pain experienced by fibromyalgia patients. This article provides an overview of fibromyalgia syndrome, which is currently thought to be partly responsible for chronic diffuse pain.
Animals ; Antidepressive Agents, Tricyclic ; Chronic Pain ; Cognitive Therapy ; Fatigue ; Female ; Fibromyalgia ; gamma-Aminobutyric Acid ; Horns ; Humans ; Memory ; Musculoskeletal Pain ; Pain Perception ; Pain Threshold ; Patient Education as Topic ; Rheumatology ; United States Food and Drug Administration ; Pregabalin

Gout, an inflammatory arthritis caused by the deposition of monosodium urate crystals, is commonly seen in primary care and specialist clinics. In recent years, there has been a resurgence of interest in gout due to advances in therapies and the understanding of pathophysiology, with new guidelines being published by international bodies. However, there is still a gap between the goals of treatment and actual day-to-day practice. Barriers that result in poorly controlled gout include patient factors such as lack of understanding of the disease, stigma and nonadherence to treatment, as well as physician factors such as knowledge gaps, inadequate use of allopurinol and lack of ownership of the disease. The medical profession needs to do more to bridge the gap through physician and patient education, identification of treatment targets with appropriate use of drugs, and dissemination of guidelines.
Allopurinol ; therapeutic use ; Arthritis ; therapy ; Comorbidity ; Gout ; drug therapy ; Humans ; Hyperuricemia ; drug therapy ; Inflammation ; Medication Adherence ; Patient Education as Topic ; Primary Health Care ; Professional-Patient Relations ; Rheumatology ; methods ; Singapore ; Uric Acid ; therapeutic use