How Multiple Sclerosis Is Different In Blacks

Nurse checking patient's blood pressure
Studies show that while whites are twice as likely as Blacks to suffer from multiple sclerosis (MS), blacks suffer from more MS risks, and a larger variety of more dangerous symptoms.

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Neurology researchers has found that, in Blacks, the disease progresses more rapidly – and that they don’t respond as well to therapies.

Magnetic resonance images (MRI) of a cohort of 567 consecutive multiple sclerosis patients showed that blacks with multiple sclerosis had more damage to brain tissue and had less normal white and grey matter compared to whites with the disease.

“Black patients showed more brain tissue damage and accumulated brain lesions faster than whites, along with rapid clinical deterioration,” confirms first author on the study Bianca Weinstock-Guttman. “The results provide further support that black patients experience a more severe disease, calling for individualized therapeutic interventions for this group of multiple sclerosis patients.”

Since the median time to both MS diagnosis and MS onset to treatment was significantly shorter for blacks compared with the whites, it is likely that the increased risk of disability for blacks is independent of health care access.

It has also been noted that Blacks with MS were more likely to present with multifocal signs and symptoms, were more likely to have clinical involvement restricted to the optic nerves and spinal cord (opticospinal MS), and were more likely to develop transverse myelitis compared with white Americans with MS.”

More Details About Racial Differences in Multiple Sclerosis

Time to Diagnosis: The groups differed in how long it took to get diagnosed after they started experiencing MS symptoms. Blacks were diagnosed about a year after symptom onset, while the white participants were diagnosed two years after their symptoms started. One theory is that the black patients were experiencing more severe symptoms, which led to a quicker diagnosis.

First Symptoms: Black patients tended to have more diverse symptoms at disease onset, caused by multiple lesions in different places in the central nervous system, than the white group did. However, about 18% of blacks had symptoms restricted to the optic nerves and spinal cord, while only 8% of the white participants had lesions limited to these areas. The white people in the study were more likely to have lesions on their brains.

Start Treatment Faster: Blacks started treatment with a disease-modifying therapy an average about 6 years after onset of symptoms, compared to 8 years elapsing between start of symptoms and initiation of treatment in the white group. Much like being diagnosed more quickly after symptom onset, it is hypothesized that perhaps the black participants were experiencing more severe or disabling symptoms and this led to their physicians recommending treatment earlier.

Interestingly, there were differences in the approach to treatment, as white participants had switched treatment more often. Also, 13 white participants had been treated with pulsed Solu-Medrol, while none of the black participants had received this type of treatment.

Mobility Differences: From this study, it appears that African Americans are somewhat more likely to develop mobility problems than white Americans. There was a 1.67-fold greater risk that black participants would eventually need a cane to walk. This also happened about 6 years earlier in the black group than in the white group (after 16 years vs. 22 years).

There seems to also be evidence that African Americans have a higher chance of becoming dependent on a wheelchair, however, a deeper analysis shows that part of the reason for this is because African Americans in the study were on average 2.5 years older at disease onset (being older at disease onset is predictive for more disability) than the white participants.

The median time until wheelchair dependency (when it happened) was 8 years shorter for African Americans (30 years after disease onset) than for whites (38 years after disease onset).