Ann Rheum Dis: first published as 10.1136/ard.25.1.25 on 1 January 1966. Downloaded from Ann. rheum. Dis. (1966), 25, 25. RHEUMATIC COMPLAINTS IN URBAN AND RURAL POPULATIONS IN OSAKA BY KANJI SHICHIKAWA, AKIRA MAYEDA, YOSHIO KOMATSUBARA, TADASHI YAMAMOTO, OSAMU AKABORI, ICHIRO HONGO, TOYOJI KOSUGI, AND TOSHIHIKO MIYAUCHI Department of Orthopaedic Surgery, Osaka University Medical School, Osaka AND MASAMI ORIHARA AND AKIRA TANIGUCHI Orthopaedic Unit, Kansai-Rosai Hospital, Amagasaki, Japan This survey was made to obtain reliable data for The survey was made during June and July 1961 in the prevalence of rheumatic complaints in Toyonaka Toyonaka, and during January and February 1962 in and in Tojo, Tondabayashi. The population sample Tondabayashi. was examined at home by physicians experienced in In Toyonaka, subjects were selected at random from a the diagnosis of rheumatic diseases. Inquiry was schedule made by the Welfare Minister in connexion with a population survey of pulmonary tuberculosis a few made into all rheumatic complaints especially rheu- months previously. This provided information about matoid arthritis in both urban and rural areas. household composition, economic status, and health conditions. For this schedule, the whole population copyright. The Method of Survey of the ten districts selected was surveyed. In the Tojo Toyonaka and the Tojo district in Tondabayashi in the district all the families were interviewed beforehand by suburbs of Osaka were selected as representative urban medico-social case workers at a health-entre in the area and rural areas. Toyonaka lies north-west of Osaka, and and information was collected about health and economic is a residential area with a population of about 215,000. status. Tondabayashi lies at the foot of the Kongo mountains Doctors in charge of the Rheumatic Clinic at the which bound the south-eastern part of the Osaka plain, Department of Orthopaedic Surgery, Osaka University and has a population of about 38,000. The rural Medical School, interviewed the families at home, and http://ard.bmj.com/ locality is the Tojo district, an area surrounded by asked whether they had suffered or were suffering tangerine-growing mountains and recently incorporated from rheumatism, lumbago, sciatica, shoulder pain, into Tondabayashi. arthralgia, arthritis, or any other aches or pains. Positive At the time of the survey the population of Toyonaka answers were followed by a check of the medical history; showed a monthly increase of 0 * 5 per cent., the increase the rheumatic complaints were investigated by simple from immigration being four times higher than the clinical examinations and were classified, if possible, into natural increase. Tojo, Tondabayashi, showed a the pre-determined diagnostic categories. very low monthly increase (0 *09 per cent.), the natural However, a single clinical examination is not always on September 24, 2021 by guest. Protected increase being slightly in excess of the decrease by sufficient to diagnose cases of rheumatic diseases, parti- emigration. cularly transient painful episodes of fibrositis, neuritis, Regarding the occupations of families, office jobs and myalgia and lumbago. A diagnosis of osteo-arthrosis labouring account for 67 per cent. in Toyonaka, and or intervertebral disk degeneration was established only in farming for 72 per cent. in Tojo (Table I). those with marked clinical and x-ray findings, although a more detailed examination would have identified more TABLE I such cases. Patients whose diagnoses were equivocal, ROUGH CLASSIFICATION OF OCCUPATIONS OF or who required further examination were referred to HOUSEHOLDS SURVEYED (PERCENTAGE) their respective health centres or asked to visit the Rheumatic Clinic, Osaka University; 43 patients in Area Farm- Office Labour- Corn- Others ing Work ing merce Toyonaka and 49 in Tojo responded, giving completion rates of 35 and 100 per cent. respectively. Patients with Toyonaka .. 3 50 17 11 19 Tojo,I limited mobility were x rayed at home and had specimens Tondabayashi .. 72 17 1 2 8 of blood taken. The diagnosis of rheumatoid arthritis Total . 27 38 1 1 8 16 was based upon clinical signs, radiological findings, and serological tests. A diagnosis of definite or probable 25 Ann Rheum Dis: first published as 10.1136/ard.25.1.25 on 1 January 1966. Downloaded from 26 ANNALS OF THE RHEUMATIC DISEASES rheumatoid arthritis was established according to the The prevalence of rheumatic diseases was classi- criteria of the American Rheumatism Association fied as follows: (Ropes, Bennett, Cobb, Jacox, and Jessar, 1957). The survey covered 779 families and 2,996 persons A. Inflammatory Rheumatic Arthritis (1,465 males and 1,531 females) in Toyonaka, and 396 families and 2,023 people (1,035 males and 988 females) (a) Rheumatoid Arthritis.-There were ten in Tojo (completion rates of 90 3 and 97 per cent. female cases of definite rheumatoid arthritis and five respectively). Those older than 65 years were predominant (one male, four females) of probable rheumatoid in Tojo (P<0 01), and those of 25 to 34 years in Toyon- arthritis, totalling fifteen cases (0 3 per cent.) for the aka (P<0-01). two areas (Table II). No difference was observed between the two areas. The prevalence among Results adults of over 20 years of age was 0 5 per cent. Painful complaints of all kinds were found in 595 Functional disturbances of Class 3 were found in (12 per cent.); 295 (10 per cent.) in Toyonaka and three cases (0-06 per cent. of the whole population 300 (15 per cent.) in Tojo. and 0 09 per cent. of those above 20 years of age). The slightly higher figure for the rural area is These rheumatoid arthritis cases are listed in Table statistically significant (P <0 01). The difference III (opposite). might be partly due to the fact that the survey in No family had more than one case of rheumatoid Tojo was made during the winter, though the year arthritis, but there were two instances of familial happened to be unseasonably warm. It must also aggregation of subacute rheumatic arthritis. be taken into consideration that the people of The sensitized sheep-cell agglutination test Toyonaka have easy access to physicians, while in (S.C.A.T.: Heller-Svartz's method) and slide latex- Tojo there is only one doctor's consulting room so fixation test were performed in eleven cases, six that mild cases are likely to be left untreated. Those (55 per cent.) of which were positive in both tests. with a past history of rheumatic diseases numbered Regarding living conditions, most of the cases 185 in Toyonaka and 81 in Tojo. occurred in families with four to six members, occasionally as many as eight. Economically, threecopyright. 1. Prevalence of Rheumatic Complaints belonged to an upper class, eight were middle class, Rheumatic complaints were found in 334 cases and four were a lower class. Ten lived in a farming (7 per cent.); 161 (5 per cent.) in Toyonaka and 173 or low marsh area, and five in a residential area. (9 per cent.) in Tojo, with a dominance in the latter (P <0 01). If those with past history are added, (b) Other Arthritis (Table IV, opposite) there are 271 cases (9 per cent.) in the former and (i) Rheumatic Fever.-One man was found to have 206 cases per in the latter, showing little (10 cent.), rheumatic fever and two cases (one male. one female)http://ard.bmj.com/ difference (Table II). had a past history. It must be conceded that this disease TABLE II TOTAL RHEUMATIC COMPLAINTS AND CASES OF RHEUMATOID ARTHRITIS, BY AGE AND SEX, IN TOYONAKA AND TOJO. TONDABAYASHI Total Rheumatic Complaints Rheumatoid Arthritis on September 24, 2021 by guest. Protected Age _ Sex Male Female Total Male Female Total Area (yearss) ___ -! __ _ Per Per Per Per Per Per Male Female INo. cent. No. cent. No. cent. No. cent. No. cent. No. cent. -_ ___ . __ _ _ -IA4 405 361 0-2 0 3 2 0 3 15-2a4 272 293 0 4 4 1 4 5 0o9 Toyonaka 25-3A4 238 278 2 1 15 5 17 3 2 2 35-4A4 185 207 5 3 26 13 31 8 45+ 365 392 40 11 66 17 106 14 6 68 ~l -1 Totatl 1,465 1,531 49 3 112 9 161 5 8 0 5 8 0-3 - - -14 305--- 247- -- 0- 3- 0 0 0O*2 l 15-24 199 153 0-5 2 1*3 3 0. Tojo, Tondabayashi 25-34 144 127 4 3 11 9 15 6.- 35-44 121 141 8 7 13 9 21 8 1 2 45+ 266 320 48 21 85 27 133 23 1 I~i I Total 1,035 988 62 6 111 11 173 9- 1 10.1 ~6 .0-6 7 1 0 3 Ann Rheum Dis: first published as 10.1136/ard.25.1.25 on 1 January 1966. Downloaded from RHEUMATISM IN URBAN AND RURAL POPULATIONS 27 TABLE III CLINICAL FEATURES OF RHEUMATOID ARTHRITIS PATIENTS No. Age Known RA Test *S.C.A.T. Area of'Cases (years) Sex Diagnosis Duration Stage Class (Slide Latex- Titre (years) Fixation) 1 50 Female Definite 10 4 2 ? 2 74 Female Definite 20 4 2 ? 3 36 Female Definite 7 4 3 + 56 Toyonaka 4 25 Female Definite 5 3 1 + 112 5 51 Female Definite 5 2 2 ? 6 51 Female Probable 1 ? 7 62 Female Probable 3 -28 -________ 8 27 Female Probable 0-17 -28 9 77 Female Definite 20 4 3 -14 10 74 Female Definite 10 4 3 + + 112 11 70 Female Definite 4 3 2 -28 Tojo 12 78 Female Definite 30 4 2 + 56 13 52 Female Definite 30 4 2 -28 14 61 Male Probable I + 56 15 39 Female Probable 3 ?56 *> 56 defined positive.