非洲裔美国人的强直性脊柱炎有何不同

“The research on this topic is very limited,” saysNilasha Ghosh医学博士，硕士，纽约市特殊外科医院的风湿病学家。确实存在的研究表明了一个惨淡的现实：一个发表在临床风湿病学, found that despite being diagnosed at lower rates than white and Hispanic patients, Black patients reported greater discomfort and impairment, had higher blood markers of inflammation, and showed more joint damage and deterioration on radiological scans (including X-rays and MRIs). Another study in the风湿病学杂志发现与白人患者相比，具有较高疾病活动和合并症的非裔美国人。

Ghosh博士说，尽管考虑到医疗保健中的偏见如何影响黑人患有其他疾病的黑人，但没有太多关于如何在美国医疗保健系统中接受治疗的数据的数据，但可能有一些因素在起作用。由于地理或社会经济原因，缺乏获得专家和药物的机会是两个大型。另一个是，医生和“白人疾病”经常被教导，戈什博士说。“因此，可能存在无意识的偏见，即即使有经典症状，也不会在非白人中发生这种情况。”

Ghosh博士指出，没有足够的黑人在研究中包括在研究中得出关于遗传风险的明确结论，以及诸如社会经济地位之类的因素尚未得到充分探讨。在一个letter to the editorresponding to that风湿病学杂志study, experts point out that findings on racial differences in AS are likely skewed by how the research was done. For example, they note that only 8% of patients in the study were African American, and only patients who had at least two rheumatologist visits were included, excluding any patients who lack access to specialists.

There’s a gene, HLA-B27, that is associated with spondylopathy, explains马格达莱纳学员, M.D., a rheumatologist at NYU Langone in New York City. According to研究, the majority of people with AS have this gene. “This gene is most often found in Caucasians, so it may not be checked for in Black Americans,” Dr. Cadet says. Thing is, while the gene can help assess risk, you don’thaveto have it to have AS. And研究suggests最多有60％的非洲裔美国人确实拥有它 - 当然，比90％的白人拥有它的百分比较低，但绝对没有。

医师偏见可以拖出诊断，从而进步。Ghosh博士说：“早日诊断非常重要，因为随着时间的流逝，由于造成损害而未经治疗。”“不幸的是，这可能意味着侵蚀性疾病”和不可逆转的联合错位。如果您的医生没有认真对待您的AS症状，那么您可能不会得到准确诊断所需的扫描和血液检查。“在某些少数民族人群中，这些测试可能不会较早进行。到他们被诊断出来时，已经建立了损害，当时已经存在严重疾病。”学员博士说。

ResearchCadet博士说，在许多炎症性疾病中，黑人在白人患者的早期就没有提供生物制剂。其他类型的治疗可能会有所帮助，但事实证明，生物制剂最有效地打击炎症和减缓疾病活动。学员说，这种差异的原因尚不清楚，但是有一些理论。她说：“少数民族通常因痛苦而遭受不足。”“由于这种偏见和其他偏见，可能无法进行炎症标记或MRI的血液检查，并且可能无法提供早期生物制剂。”

Another reason AS may be more severe in Black people is because this population has a higher incidence of having simultaneous health conditions that can add to the overall levels of inflammation in the body, Dr. Cadet says—andinflammation is what drives AS symptoms。“Black Americans tend to have [a higher incidence of] comorbidities likehigh blood pressure,diabetes, orbetway168 , and that can also affect disease activity.” Unfortunately, having AS also puts a person at risk of these same comorbidities, adding to the disease burden for people who already are actively dealing with them.

Because of healthcare biases, Dr. Cadet notes that often Black people may not receive as much education and communication from their doctors, leading to a delay in diagnosis. “Black populations may not be as readily aware of AS symptoms—back pain and stiffness that gets better with exercise, early morning stiffness, or other symptoms, like trouble breathing because of rib inflammation, or eye pain,” Dr. Cadet says. This can make it difficult for patients to know that something like AS may be lurking, and that they need to ask for more tests—or even a second opinion.

由于具有AS症状的人通常会首先见到他们的初级保健医生，因此Ghosh博士说接受教育全部AS症状的患者是较少的黑人陷入裂缝的重要第一步。Cadet博士说，此外，需要将更多的黑人包括在AS研究中，以更好地了解这种疾病如何真正影响这一人群。同时，Cadet博士建议您熟悉AS的症状，去看医生，如果您遇到他们的症状，如果您的医生没有认真对待您，请尽快熟悉并获得第二意见。“这一切都归结为成为您自己的拥护者。”