A pilot study comparing the results of treatment for rheumatoid arthritis in African-Americans and Caucasians has revealed that African-Americans are more likely to suffer pain and disability from the disorder.
University researchers used questionnaires, physical examinations and laboratory tests to assess symptoms and disability levels in 33 African-Americans and 67 Caucasians.
“Both disease activity and the resulting disabilities were worse in African-Americans,” said senior investigator Richard D. Brasington, M.D., associate professor of medicine.
“Further analysis of our results showed that this was linked primarily to their socio-economic status, not to their race.”
Differences in insurance status — whether a patient had private insurance or public insurance — did not seem to influence patient outcomes.
However, many of the African-American patients had lower scores in self-efficacy, a characteristic that describes a patients’ belief in his or her ability to control or otherwise have a positive effect on disease symptoms.
Earlier studies highlighted poor outcomes and low self-efficacy scores among African-American patients with other chronic diseases such as lupus and scleroderma.
Brasington couldn’t find any information on disparities in outcome for the rheumatoid arthritis patients he sees.
Therefore, he decided to conduct his own study.
“The sample size was small, but before doing a study with hundreds of people it makes sense to see if we could produce some tentative evidence that a difference in outcome does indeed exist,” he said.
“And it’s important to note that, at least in our community, African-Americans with rheumatoid arthritis aren’t doing as well.”
Rheumatoid arthritis afflicts approximately 2.1 million Americans.
Women are 2-3 times more likely to develop the disorder than men.
Rheumatoid arthritis has long been recognized as an autoimmune condition, which involves defensive cells in the body’s immune system mistakenly attacking healthy body tissues.
Symptoms, which often occur in episodic bursts, include morning stiffness, fatigue and joint and muscle pain.
In severe cases, rheumatoid arthritis can damage cartilage, tendons, ligaments and bone, leading to joint deformity and instability.
Patients are typically treated with a mixture of medications to reduce inflammation and control pain.
Brasington suggests that doctors should try to boost the belief of African-American patients that they can take steps to control their disease and decrease the symptoms.
“We can’t really do much about our patients’ socio-economic status, but we could focus some effort on improving self-efficacy,” Brasington said.
“The Arthritis Foundation, for example, offers a formal class called the ‘Arthritis Self-help Course’ that can improve self-efficacy, and this has been linked to reductions in some measurements of disease activity.”
As a result of the pilot study, Brasington and his colleagues have become involved in a multicenter study of early rheumatoid arthritis in African-Americans.