Black Arthritis Patients Get Less Powerful Drugs

man red joint pain
Blacks with rheumatoid arthritis are only half as likely to be prescribed more effective drugs that may prevent further joint damage and disability, according to a new study published in the journal Arthritis Care & Research.

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For the study, researchers surveyed 5,385 rheumatoid arthritis Medicaid patients between ages 50 and 70 in California who were being treated with at least one anti-rheumatic drug between 1998 and 2005. Scientists reviewed participants’ records to identify any differences in the way patients from different racial and ethnic groups were being prescribed anti-arthritis medication, despite similar income level and arthritis severity.

In addition, researchers determined if patients were prescribed the more potent, biologic disease-modifying anti-rheumatic drugs (DMARDs), or the less powerful standard DMARDs.

Study findings revealed only 9 percent of African-American patients (compared with 16 percent of white patients) were prescribed the more powerful biologic DMARDs, marketed as Enbrel and Humira. What’s more, 20 percent of Latino patients were prescribed biologics, but this group typically had more severe joint pain and inactivity than whites.

Why were doctors less likely to prescribe the stronger anti-arthritis drugs to black patients? Well, researchers point to several possible reasons: African-American patients may lack access to specialists well versed in rheumatoid arthritis management; ethnic and cultural beliefs may stop minorities from immediately seeking care; black people know few in their community who take biologic DMARDs; and doctors may be unaware of how severe the arthritis is in certain people.

“If cultural beliefs inhibit a [rheumatoid arthritis] patient from seeking care immediately, the window of opportunity for treatment may be lost,” said Aniket A. Kawatkar, PhD, a researcher at the Southern California Permanente Medical Group in Pasadena.

Researchers also emphasized that, ideally, a rheumatologist would assess each person’s condition and then prescribe the appropriate med.

Knee Pain: Surgery Or Therapy?

A man on a basketball court floor holding his leg and wincing in painMany adults suffer from knee pain, and wonder if therapy or surgery is the best way to treat it. Are you one of them? Are you desperately in need of relief, willing to try anything to regain your mobility, even if it means surgery?

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Well, you might not want to rush into knee surgery. Physical therapy can be just as good for a common injury and at far less cost and risk, the most rigorous study to compare these treatments concludes.

Many middle-aged and older adults have severe knee pain due to a tear in the meniscus, a crucial support structure in the knee that is often damaged in people with knee osteoarthritis.

Each year in the United States, more than 450,000 arthroscopic surgeries are performed to treat meniscal tears, but scant data exist to help doctors determine if physical therapy or surgery is the best treatment for a patient, according to the researchers at Brigham and Women’s Hospital in Boston.

Their study of 351 patients — all over age 45 with knee pain, meniscal tear and knee osteoarthritis — suggests that physical therapy may be equal to surgery for some patients.

Participants were randomly assigned to be treated with either arthroscopic surgery or physical therapy. When they were assessed six and 12 months later, both groups had substantial and similar improvements in movement.

The study was scheduled for presentation this week at the annual meeting of the American Academy of Orthopaedic Surgeons, in Chicago, and published online March 19 in the New England Journal of Medicine.

“Since both the patients who received physical therapy and those who received surgery had similar and considerable improvements in function and pain, our research shows that there is no single ‘best’ treatment,” principal investigator Dr. Jeffrey Katz said in a hospital news release.

However, the release noted that some of the original physical therapy patients did eventually opt for surgery.

“Patients who wish to avoid surgery can be reassured that physical therapy is a reasonable option, although they should recognize that not everyone will improve with physical therapy alone. In this study, one-third of patients who received physical therapy ultimately chose to have surgery, often because they did not improve with [physical therapy],” added Katz, who is director of the Orthopedic and Arthritis Center for Outcomes Research at Brigham and Women’s Hospital, and a professor of medicine and orthopedic surgery at Harvard Medical School.

One expert agreed with those conclusions.

“The article reinforces the standard that if a patient suffers a degenerative meniscal tear related to mild to moderate osteoarthritis then the first line of treatment is typically physical therapy,” said Dr. Leon Popovitz, an orthopedic surgeon at Lenox Hill Hospital in New York City.

“If patients do not improve, then arthroscopy is a viable option to improve their symptoms,” he added.