By: Diane Wedner.
Hispanics and African-Americans have worse symptoms of arthritis than the general population and face greater disability and work limitations. Lifescript’s Health Detective explains why, and what minorities with arthritis can do to take care of themselves…
Aching, swollen knees hobbled Kimberly Felder for nine years.
“I could barely move,” says Felder, 41, a New York City educator. “It took 10 minutes to walk to the bathroom. My knee was the size of a grapefruit.”
Her doctor’s diagnosis: rheumatoid arthritis (RA), an inflammatory disease that causes joint pain and inflammation.
Felder, who’s African-American, is one of 7.7 million minorities with arthritis. The disease hits minorities harder than the general population. They develop more crippling arthritic conditions, such as rheumatoid arthritis (RA) and lupus. They also face more disability, according to a 2010 study by the Centers for Disease Control and Prevention (CDC).
Minorities also are twice as likely as whites to have severe joint pain and lose work days because of the disease, according to the study.
Doctors aren’t sure why – but there are clues, says Patience White, M.D., a professor of medicine at George Washington University School of Medicine and Health Sciences.
“Many patients in [the minority] community don’t go to the doctor early enough” in the disease’s course, Dr. White says. “By the time they’re diagnosed, they have worse disability.”
They also have higher rates of obesity, which worsens symptoms of arthritis.
Here are the main reasons why African-Americans and Hispanics may suffer greater arthritis disability, along with arthritis remedies to help reduce the risk.
African-Americans and Hispanics have higher rates of obesity in the U.S. than Caucasians, putting them at greater risk for arthritis and other conditions that worsen arthritis symptoms, according to the CDC report. About 44% of African-Americans are obese, while 38% of Hispanics are, compared with about 33% of whites.
Chronic conditions associated with obesity, such as heart disease and diabetes, make it more difficult for arthritis patients to exercise, worsening their arthritis symptoms and making them more dependent on others, doctors say.
Obesity is the biggest factor in disabling symptoms of arthritis, says Melvyn Harrington, M.D., an orthopedic surgeon and associate professor at Baylor College of Medicine in Houston, Texas.
“I talk more about weight loss with my arthritis patients than joint replacements,” he says.
Here’s why: If you’re overweight, every step puts eight times that weight’s force on your knees and hips, says rheumatologist Eric P. Gall, M.D., professor of clinical medicine and interim director of the Arizona Arthritis Center at the University of Arizona College of Medicine.
“If you’re 10 pounds overweight, you’re adding 80 pounds to that joint with every step,” Dr. Gall explains.
-Shedding pounds is the best way to avoid the worst symptoms of arthritis, doctors contend. “Losing just 10% of your weight decreases your pain by 50%,” Dr. White says.
-Walking, swimming and tai chi are gentle ways to lose weight and keep pounds off, Dr. White says. Strengthening and stretching exercises toughen the muscles around joints, delaying wear and tear on knees and hips, she adds.
2. Family history
Minorities face more pain and disability from arthritis because they often experience the most severe, systemic forms of the condition, such as RA and lupus, which attack many organs and the whole body, says Jennifer Hootman, Ph.D., a CDC epidemiologist and co-author of the study.
Sometimes those conditions are passed down genetically. Lupus patients, for example, may inherit a susceptibility to the condition from their parents, according to the Lupus Foundation of America.
Although there are no genetic tests to determine whether you’re at risk, researchers are conducting “linkage studies,” in which they evaluate families with more than one member who has lupus.
RA isn’t hereditary, but certain genes may increase your risk of developing the disease.
You have up to a 4% chance of developing RA if your mother, father, sister or brother has it, according to Harvard Medical School. In the general population, 1% runs that risk.
-Get as complete a family medical history as possible.
-Consult with a rheumatologist if one or more members of your family have lupus or RA.
3. Ignoring symptoms
-Minority women are more likely to ignore their aching joints and inflammation. One reason: cultural attitudes.
“If you ask people with arthritis what their No.1 issue is, it’s pain,” Dr. Gall says.
But in some ethnic communities, “they’re told by family members … that you just get arthritis when you’re old and there’s nothing you can do about it,” Dr. Gall says. “So they don’t seek help.”
Many also are more worried about having bigger health problems, such as heart disease, hypertension or diabetes, three of the leading co-conditions of arthritis.
“When you get [minorities] with all the co-conditions, arthritis is way down on their list of complaints for their primary care physicians to address,” Dr. Harrington says. “They’re worried about heart disease and blood pressure, so they don’t even mention achy joints.”
That delay carries a high price. Hispanic and African-American patients typically have worse preoperative hip and knee function before surgery than white patients, according to a 2010 report published in The Journal of Arthroplasty.
Ignoring symptoms of arthritis leads to more severe conditions later, doctors say.
By the time patients do seek help, the remedies aren’t as effective or are more invasive. And at these later stages, the outcome may not be as beneficial.
For example, a white male with 75% joint erosion will enjoy a 90% improvement after surgery, Dr. Harrington says, while an African-American woman’s joint will improve only 80%.
“There’s no catch-up phenomenon when you’re advanced,” he says. “It’s too late for less-invasive tools.”
-Visit a doctor if any symptoms of arthritis flare, such as painful, swollen joints, rashes, fatigue and fevers. The earlier the diagnosis and treatment by a rheumatologist, the better the result.
-Even if you have heart disease, diabetes or other serious health conditions, speak up about your symptoms of arthritis to your doctor. Don’t assume that aching joints are a minor problem.
-Educate yourself and others.
“It’s vital to get the word out about arthritis,” Dr. Harrington says. “Minority patients – and everyone, for that matter – need to know the effects of this condition” and the damage it causes.
4. Lack of health insurance, and other impediments
Even when African-American and Hispanic arthritis patients want care, they may not be able to get it, doctors say.
“Some minority patients don’t have health insurance,” Dr. Harrington says. “They also may not have access to an orthopedist for surgery.”
If African-American patients do have access, “often they want to see African-American orthopedists,” Dr. White says, because they place their trust in black doctors more readily than white ones.
But, depending on the geography, they may not be easily available.
About 75% of physicians identified themselves as white, while 4% were African-American and 5.3% Hispanic, in a 2008 Health Tracking Physician Survey by the Center for Studying Health System Change.
Meanwhile, some patients with insurance don’t know that orthopedic surgeries are covered, so they don’t consider that option, Dr. White says. Undergoing the surgery without insurance coverage would be prohibitively expensive.
“Access and health insurance are the two biggest obstacles to arthritis treatment,” Dr. White says.
With undocumented Hispanics, immigration fears may prevent them from seeking a doctor’s care at county facilities, making them especially at risk for advanced disease, doctors say. Family responsibilities keep them away from doctors too.
“Women who are the mainstays of their family units don’t have time for surgery,” Dr. White says.
For example, knee surgery is a “major operation,” with full recovery taking 6-12 months, Dr. Harrington says. Patients must be healthy enough to undergo physical therapy before and after the operation, and be able to undergo anesthesia. Patients return to most activities in 2-3 months.
Arthritis patients who also have diabetes and heart disease may be poor candidates for surgery, even if they have insurance. And those who wait too long before seeking relief may be out of luck.
-Get informed. Hispanics and African-Americans seeking safe, affordable care for arthritis may find information at local churches and schools.
-Know your options. Patients should ask their primary care physicians about surgical options under their health insurance policies, and seek detailed information from doctors about the disease.
While many challenges exist for African-American and Hispanic patients with symptoms of arthritis, they can manage the condition.
It takes the right information and attitude, says Felder, the New York schoolteacher.
“The best way to do that is to not just take care of yourself through exercise and diet, but by getting the medical attention you need,” Felder says. “That’s what I did. And it worked.”
How Much Do You Know About the Types of Arthritis?
About 46 million American adults – nearly one in five – suffer from some type of arthritis. It’s estimated that number will rise to 67 million by 2030. Do you or someone close to you have arthritis? Take this quiz to see how much you know about this disease.