• Anthropometry and Clinical Features of Kashin-Beck Disease in Central Tibet.

      Mathieu, F; Begaux, F; Suetens, C; De Maertelaer, V; Hinsenkamp, M; Médecins Sans Frontières, Département Médical, Bruxelles, Belgium. (Springer, 2001)
      We compared two different populations living in central Tibet with the purpose of establishing standard values for different anthropometric parameters in a rural population. Later on, these values were used as references for a similar study on a KBD population. One group (KBD) (n=1,246) came from the endemic areas, and the other group, serving as the control population (n=815), came from non-endemic areas. Both groups included children and adults and were of the Mongoloid type; they were farmers or semi-nomads. Height, weight, segment length, joint perimeter, joint diameter, joint movement were recorded. Also more subjective information such as general feeling of tiredness, rapid fatigue at work, work limitation, joint pain, muscle weakness, muscular atrophy, dwarfism, flatfoot, and waddling gate was also collected. Those variables were compared between the two groups.
    • Clinical Manifestations of Kashin-Beck Disease in Nyemo Valley, Tibet.

      Mathieu, F; Begaux, F; Lan, Z Y; Suetens, C; Hinsenkamp, M; Médecins sans Frontières, Lhasa, Tibet Autonomous Region. (Springer, 1997)
      Clinical manifestations of Kashin-Beck disease have been studied in Central Tibet. Statistical analysis of physical signs allowed a definition of the clinical diagnosis and a scale for the functional severity for the disease to be drawn up. This classification is used for the assessment of patients who received palliative physical treatment. A group of 136 patients have been examined and their disabled joints classified according to pain, bony enlargement and restriction of movement. 57% were between 20 and 35 years of age. The patients mainly complained about their distal weightbearing joints. The clinical evolution of the disease is described from childhood to adult life.
    • Effects of Physical Therapy on Patients with Kashin-Beck Disease in Tibet.

      Mathieu, F; Suetens, C; Begaux, F; De Maertelaer, V; Hinsenkamp, M; Médecins Sant Frontières, Département Médical, Brussels, Belgium. francoise.mathieu@msf.be (Springer, 2001)
      A clinical trial of physical therapy treatment for patients suffering from Kashin-Beck disease (KBD) has been carried out in Tibet. One-hundred and thirty-five patients with Kashin-Beck disease were allocated to either physical therapy (72 patients) or prescription of multivitamins (63 patients). The patients were followed for 4 years. This study suggested a beneficial effect of physical treatment.
    • Epidemiological Support for a Multifactorial Aetiology of Kashin-Beck Disease in Tibet.

      Suetens, C; Moreno-Reyes, R; Chasseur, C; Mathieu, F; Begaux, F; Haubruge, E; Durand, M; Nève, J; Vanderpas, J; Médecins Sans Frontières, Brussels, Belgium. carl.suetens@ihe.be (Springer, 2001)
      We carried out a cross-sectional study in 12 rural villages in order to identify the risk factors for Kashin-Beck disease in Tibet. Children aged 5-15 years (n=575) were examined and their corresponding houses were visited. Samples were collected in order to study fungal contamination of stored grain and the organic matter content of drinking water. Multivariate analysis was performed using logistic regression and population attributable fractions were computed to estimate the impact of each factor. The following variables were independently associated with the disease: age, gender, low socio-economic status, indicators of a poorly diversified diet, iodine deficiency and small water container size (with higher organic matter levels in small containers). Selenium deficiency was severe in all study subjects. The degree of fungal contamination of barley grain was related to the highest percentage of cases (65%) in a sample of the study population. Higher urinary iodine levels were not associated with decreasing prevalence rates when Alternaria sp. was isolated. The data that we report supports the hypothesis that Kashin-Beck disease occurs as a consequence of oxidative damage to cartilage and bone cells when associated with decreased antioxidant defence. Another mechanism that may coexist is bone remodelling stimulated by thyroid hormones whose actions can be blocked by certain mycotoxins.
    • Kashin-Beck Disease and Drinking Water in Central Tibet.

      La Grange, M; Mathieu, F; Begaux, F; Suetens, C; Durand, M C; Médecins Sans Frontiéres, Brussels, Belgium. (Springer, 2001)
      A cross-sectional survey was carried out in order to study the relationship between Kashin-Beck disease and drinking water. The average volume of the water containers was larger in families unaffected by the disease. Organic material was measured by ultraviolet (UV) spectroscopy. The UV absorbency was significantly lower in drinking water of unaffected families. Thus, the organic material in drinking water may play a role in the pathogenesis of Kashin-Beck disease.
    • Kashin-Beck disease and iodine deficiency in Tibet.

      Moreno-Reyes, R; Suetens, C; Mathieu, F; Begaux, F; Zhu, D; Rivera, M; Boelaert, M; Nève, J; Perlmutter, N; Vanderpas, J; et al. (2001)
      We evaluated iodine and selenium status in 575 children between 5 and 15 years with Kashin-Beck disease from endemic and non-endemic areas. Of these 267 (46%) children had goiter. The proportion of subjects with goiter was higher in the villages with Kashin-Beck disease than in the control village. In the villages with Kashin-Beck disease, 105 (23%) of the subjects had a serum thyrotropin greater than 10 mU/l as compared with 3 (4%) in the control village. The percentages of low serum thyroxine values and low serum tri-iodothyronine were greater in the villages where Kashin-Beck disease was endemic than in the control village. The percentages of low urinary iodine concentration were significantly greater in the subjects with Kashin-Beck disease. The results suggest that in areas where severe selenium deficiency is endemic, iodine deficiency is a risk factor for Kashin-Beck disease.