Minorities and Rheumatic Disease

 

Rheumatic diseases can affect anyone regardless of age, gender or race, but rheumatologists have long known that certain rheumatic diseases are more prevalent in minority populations than they are in the general population. They have also known that certain rheumatic diseases differ in severity and outcome across ethnic groups. For example, African-American women are three times more likely to develop lupus than Caucasian women, with as many as one in 250 African-American women developing the disease. African-Americans with lupus are also more likely to develop severe symptoms from lupus and suffer from kidney damage caused by the disease.

The same is true of scleroderma. Other minority groups also suffer from rheumatic diseases at higher rates than Caucasians. For example, lupus is twice as prevalent in Asian-American and Latina women as it is in Caucasian women. What is less clear is why certain rheumatic diseases are more common and more severe in minority groups in the United States. Part of the reason the question is difficult to answer is because rheumatic diseases themselves are complex.

“The exact cause of rheumatic diseases is difficult to pinpoint, with most stemming from a combination of environmental, genetic, and social factors. The interplay between the genetic predisposition to rheumatic diseases, environmental triggers, and social factors like smoking and obesity, which have been linked to increased risk of developing rheumatic diseases is difficult to tease out,” says Eric Matteson, MD; ACR member and chair of rheumatology at the Mayo Clinic in Rochester, Minn.

“The direct causes of rheumatic diseases are not known,” Dr. Matteson says, “but we do know that minorities are differently affected.” Further complicating the question of why rheumatic diseases disproportionately affect minority groups are socioeconomic factors like discrimination, education, income and cultural barriers. All of these variables can play a role in the onset or severity of not only rheumatic diseases, but many other diseases as well.

For example, individuals who live in poverty, or are isolated may delay visiting a doctor and consequently suffer more adverse effects from diseases than those who seek treatment promptly. And education has been shown to have a dramatic effect on lifespan, with college graduates having a life expectancy between five and nine years longer than those who do not complete high school. “Socioeconomic factors play an important role in the outcomes of rheumatic diseases, but their prevalence among minorities is not completely explained by socioeconomic factors,” says Dr. Matteson.

While the reasons rheumatic diseases disproportionately impact minorities may be complicated, Dr. Matteson says there is much the rheumatology community can do to help mitigate the impact of these devastating conditions on minorities. There is a real need for public relations campaigns targeted toward minorities to raise awareness of rheumatic diseases, he adds. Dr. Matteson says that education is key, not just for members of at-risk populations, but for the primary care physicians who serve as front line care. Early and appropriate referrals to a rheumatologist during the window of opportunity — the first weeks and months after the onset of symptoms of a rheumatic disease —are essential to preventing long-term complications.

“[Education] is a really important effort that the medical community and rheumatologists in particular, need to pursue,” Dr. Matteson says. In addition to education of both doctors and patients, Dr. Matteson says the rheumatology community can do more to ensure minority communities are not overlooked. He says that recruiting more minorities into rheumatology, as well as funding rheumatology research aimed at minorities are essential, as well as making sure to include minority patients in drug trials. He also advocates reaching out to insurers and legislators about the need for favorable public policy that would benefit everyone affected by rheumatic diseases.

“The consequences of getting these diseases can be devastating, and the cost burden on individuals can be gigantic,” Dr. Matteson says. “However, the Simple Tasks campaign offers a solution for anyone to get involved and help lessen the burden of rheumatic diseases.” The Simple Tasks campaign, headed by the American College of Rheumatology, was created to educate lawmakers, physicians and patients on the importance of rheumatology. The goal of the campaign is to generate awareness about the more than seven million Americans living with rheumatic conditions. The campaign was also created to encourage favorable public policy that will lead to additional research funding, improved access to health care and a larger rheumatology workforce.