Lessons for Rheumatologists
“We have seen consistently across the United States that individuals with fewer years of formal education and lower markers of socioeconomic status have increased prevalence of disease, poorer outcomes and increased mortality,” says Dr. Callahan.
Rheumatologists need to bear in mind the social aspects of the lives of their patients when such a patient is in their office, says Dr. Callahan. Given rheumatologists’ frequent shortage of time, referrals for more extended patient education might be indicated.
Dr. Callahan advises use of the teach-back method to ensure patients understand how to treat themselves at home—“for instance, telling the patient, ‘We’ve covered a lot of information today; I want to make sure I’ve made myself clear. Can you tell me how you are going to manage your disease when you get home?’”
Dr. Callahan suggests rheumatologists need to make sure that at the end of the visit they encourage the patient to ask questions, by asking, “What questions do you have?” rather than, “Do you have any questions?” which she says can make a patient feel cut off.
Additionally, Dr. Callahan urges considering low socioeconomic status above race as an indicator a patient may need extra attention, “since low socioeconomic status is a marker for a whole constellation of deprivations that cut across all races.”
“This paper reminds us that [Native Americans] are also heavily affected by rheumatic disease,” says Donald R. Miller, PharmD, professor, pharmacy practice, School of Pharmacy, College of Health Professions, North Dakota State University, Fargo, who was not involved in the research. “Rheumatologists may need to be more vigilant for diagnoses in [Native Americans], and may need to take a more holistic approach to treatment in special populations.”
Jim Jarvis, MD, professor of pediatrics at the University at Buffalo, Jacobs School of Medicine, and a member of the Mohawk Nation, referring to the ongoing Adverse Childhood Experiences Study, suggests that early childhood trauma—physical or emotional—may play an important role in these diseases.3 Dr. Jarvis says that early in his examination of high rates of rheumatic diseases among Indians, a Cheyenne elder told him that to understand the high rates of lupus and rheumatoid arthritis in Indians, “look at our people and what’s happened to us.” Thus, some emphasis on early history taking may be indicated.
David C. Holzman writes on medicine, science, environment and energy from Lexington, Mass.
References
- Peláez-Ballestas I, Granados Y, Quintana R, et al. Epidemiology and socioeconomic impact of the rheumatic diseases on indigenous people: An invisible syndemic public health problem. Ann Rheum Dis. 2018 Oct;77(10):1397–1404.
- Syndemics. Lancet. 2017 Mar 2;389(10072).
- Felitti VJ, Anda RF, Norenberg D, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med. 1998 May;14(4):245–258.
