Clinical Rheumatology

, Volume 26, Issue 6, pp 853–857 | Cite as

Recommendations from the Community Oriented Program for Control of Rheumatic Disease for data collection for the measurement and monitoring of health in developing countries

  • John DarmawanEmail author
Invited Review


The history of the World Health Organization-International League of Associations for Rheumatology Community Oriented Program for Control of Rheumatic Disease (COPCORD) for developing countries is described. Due to lack of funding and manpower, the COPCORD concept is designed in three stages for execution. Stage I is a community-based epidemiology of rheumatism in three phases by rheumatologist but non-epidemiologist to save time, money, and costs. Stage II is education of treatment of rheumatism. Stage III is the identification of environmental and genetic risk factors of musculoskeletal disorders to prevent or minimize rheumatism. Since 1980, COPCORD has collected valid community-based epidemiological data, which are published in 42 papers since 1985 in various international rheumatology journals. The publications were from 19 developing countries in the Asia Pacific region, South America, Europe, and Africa. Stage II education is deemed to be more appropriate handled by allied rheumatology health professionals. Low back pain, osteoarthritis, osteoporosis, and rheumatoid arthritis (RA) are the priority. The projected prevalence of RA in >4 billion people in countries of the South are between 8 and 12 million patients and urgently require adequate control. After 5–15 years, the consequences of RA are disability, reduced productivity, loss of career and income, lowered quality of life, and early mortality notwithstanding existing therapy. The application of the Biologic DMARDs in RA in the Third World for reasons of treatment costs from $15,000 to $25,000 per patient per year is not feasible. The majority of the Third World population has an income of less than US$1.00 per day to less than US$2,000.00 per capita. The COPCORD has designed and applied successfully the step-down bridge guidelines of intravenous and oral combination of five generic immunosuppressants in prospective observational studies of rheumatoid factor positive RA in Indonesia, China, and Iran. Recommendations of the COPCORD stages are submitted.


COPCORD Education Epidemiology Risk factors Treatment 



Community Oriented Program for Control of Rheumatic Disease


rheumatoid arthritis


  1. 1.
    World Health Organization. Community oriented programmes on rheumatic diseases. NCD/OND/RH/WP/81.5Google Scholar
  2. 2.
    World Health Organization. WHO-ILAR community oriented programs on rheumatic diseases. Report by H. A. Valkenburg. NCD/OND/RH/WP/81.5Google Scholar
  3. 3.
    Wigley RD, Manahan L, Muirden KD, Caragay R, Pinfold B, Couchman KG, Valkenburg HA (1991) Rheumatic disease in a Philippine village II: a WHO-ILAR-APLAR COPCORD study, phases II and III. Rheumatol Int 11:157–162PubMedCrossRefGoogle Scholar
  4. 4.
    Grabauskas VA (1983) World Health Organization perspective. J Rheumatol Suppl 10:5–6PubMedGoogle Scholar
  5. 5.
    Darmawan J, Valkenburg HA, Muirden KD, Wigley RD (1992) Arthritis community education by leather puppet (wayang kulit) shadow play in rural Indonesia (Java). Rheumatol Int 12:97–101PubMedCrossRefGoogle Scholar
  6. 6.
    Breedveld FC, Emery P, Keystone E, Patel K, Furst DE, Kalden JR, St Clair EW, Weisman M, Smolen J, Lipsky PE, Maini RN (2004) Infliximab in active early rheumatoid arthritis. Ann Rheum Dis 63:149–155PubMedCrossRefGoogle Scholar
  7. 7.
    Roberts L, McColl GJ (2004) Tumour necrosis factor inhibitors: risks and benefits in patients with rheumatoid arthritis. Intern Med J 34:687–693PubMedCrossRefGoogle Scholar
  8. 8.
    Damarawan J, Nasution AR, Chen SL, Haq SA, Zhao D, Zeng Q, Davatchi F (2006) Excellent endpoints from step-down bridge combination theraphy of 5 immuno-suppressants in NSAID-refractory ankylosing spondylitis: 6 year international study in Asia-WHO-ILAR COPCORD stage II treatment of the autoimmune diseases. J Rheumatol 33:2484–2492Google Scholar
  9. 9.
    Darmawan J, Nasution AR, Rasker JJ, Zhao D, Soorosh S, Chen SL, Haq SA, Davatchi F (2007) Excellent results in DMARD-refractory rheumatoid arthritis with step-down bridge combination therapy of 5 immunosuppresants: a 6 years international study in Asia-WHO-ILAR COPCORD Stage II study. APLAR J RheumatolGoogle Scholar
  10. 10.
    Darmawan J, Rasker JJ, Nuralim H (2004) Ten years radiographic outcome of rheumatoid factor positive rheumatoid arthritis patients, treated with aggressive immunosuppressive combination therapy. J Rheumatol 31(Suppl 69):66–69Google Scholar
  11. 11.
    Darmawan J, Rasker JJ, Nuralim H (2003) Reduced burden of disease and improved outcome of patients with rheumatoid factor positive rheumatoid arthritis compared year observational study. J Rheumatol 67(Suppl 8):50–53Google Scholar
  12. 12.
    Kobelt G, Eberhardt K, Jonsson L, Jonsson B (1999) Economic consequences of the progression of rheumatoid arthritis in Sweden. Arthritis Rheum 42:347–356PubMedCrossRefGoogle Scholar
  13. 13.
    Wong JB, Ramey DR, Singh G (2001) Long-term morbidity, mortality, and economics of rheumatoid arthritis. Arthritis Rheum 44:2746–2749PubMedCrossRefGoogle Scholar

Copyright information

© Clinical Rheumatology 2007

Authors and Affiliations

  1. 1.WHO Collaborating Center, Community-based Epidemiology, Prevention, and Treatment of Rheumatic DiseaseIndonesia Rheumatic CenterSemarang-JakartaIndonesia

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