The British Journal of Rheumatology, Vol 36, 781-785, Copyright © 1997 by British Society for Rheumatology
K Hameed and T Gibson
The impact of environmental factors on the causation of rheumatoid
arthritis (RA) is thought to be considerable. We explored this by comparing
the prevalence of RA amongst Pakistanis living in England, where it is
relatively high amongst ethnic English, and in Pakistan. The frequency of
other rheumatic diseases was also compared. Information on 2056 adult
Pakistanis in England and 4232 in Pakistan was obtained by house-to-house
surveys using identical protocols. Positive respondents were examined by
the same two clinicians in both countries. Rheumatic complaints increased
with age and were more common in females in both communities. The
standardized morbidity ratio (SMR) (95% CI) of RA in England was 2.1
(1.1-3.1) compared with Pakistan, a difference that was entirely
attributable to females. The SMR (95% CI) for women was 3.0 (0.4-5.6) and
for men 0.86 (-0.84 to 2.56). In Pakistan, there was a trend to more
reporting of some but not all rheumatic complaints amongst the affluent
segment of the population. This was increasingly apparent amongst those
resident in England and the possibility of an impact of easier
ascertainment amongst the more educated cannot be discounted. Low back pain
was significantly more common in England. Furthermore, the colder climate
was frequently invoked as a cause of more symptoms in England. Thus,
several factors may have influenced the observation that RA is more common
amongst Pakistanis in England compared with Pakistan. An environmental
factor cannot be excluded. However, the frequency of non-specific
musculoskeletal pain was similar. The regions of Pakistan from which the
two populations were derived were also different and immunogenetic
heterogeneity might also have contributed to the difference in RA
prevalence.
ORIGINAL PAPERS
A comparison of the prevalence of rheumatoid arthritis and other rheumatic diseases amongst Pakistanis living in England and Pakistan
Aga Khan University Hospital, Karachi, Pakistan.
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