Pilot study finds poorer outcomes for African-Americans with rheumatoid arthritis

Arthritis and resulting disabilities appear worse in African-Americans

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.

African-Americans are more likely to suffer pain and disability from arthritis.
African-Americans are more likely to suffer pain and disability from arthritis.

Researchers at Washington University School of Medicine in St. Louis 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,” says senior investigator Richard 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, for example — 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, who is on staff in the rheumatology division at Barnes-Jewish Hospital, couldn’t find any information on disparities in outcome for the rheumatoid arthritis patients he sees and therefore decided to conduct his own study.

Richard Brasington
Richard Brasington

“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 explains. “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 or about 1 percent of the population. Women are two to three 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 consider the possibility of trying to boost the belief of African-American patients that they can take steps to control their disease and decrease the symptoms they suffer.

“We can’t really do much about our patients’ socio-economic status, but we could focus some effort on improving self-efficacy,” Brasington says. “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 their work on the pilot study, Brasington and his colleagues at Washington University School of Medicine have become involved in a multicenter study of early rheumatoid arthritis in African-Americans. The study group, funded by the National Institutes of Health, is called the Consortium for Longitudinal Evaluation of African-Americans with Early Rheumatoid Arthritis.

Iren UT, Walker MS, Hochman E, Brasington R. “A pilot study to determine whether disability and disease activity are different in African-American and Caucasian patients with rheumatoid arthritis in St. Louis, Missouri, USA.” Journal of Rheumatology, April 2005.

Funding from the Eastern Missouri chapter of the Arthritis Foundation supported this research.

Washington University School of Medicine’s full-time and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children’s hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked third in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children’s hospitals, the School of Medicine is linked to BJC HealthCare.