Clinical characteristics Of African Americans Vs Caucasian Americans With Multiple Sclerosis
Cree BA, Khan O, Bourdette D, Goodin DS, Cohen JA, Marrie RA, Glidden D, Weinstock-Guttman B, Reich D, Patterson N, Haines JL, Pericak-Vance M, DeLoa C, Oksenberg JR, Hauser SL
Neurology 2004 Dec 14;63(11):2039-45
University of California San Francisco, Multiple Sclerosis Center, Department of Neurology, 350 Parnassus Ave., Suite 908, San Francisco, CA 94117, USA
African American (AA) individuals are thought to develop Multiple Sclerosis (MS) less frequently than Caucasian American (CA) individuals.
Objective & Methods
To compare the clinical characteristics of AA and CA patients with MS, the clinical features of MS were compared in a large retrospective cohort of AA (n = 375) and CA (n = 427) subjects.
The proportion of women to men was similar in AA and CA subjects (81% [AA] vs 77% [CA]; p = 0.122).
There were no differences in the proportions of subjects with Relapsing/Remitting, Secondary/Progressive, Primary/Progressive, and Progressive/Relapsing MS.
The median time to diagnosis was 1 year after symptom onset in AA subjects and 2 years after symptom onset in CA subjects (p = 0.0013).
The age at onset was approximately 2.5 years later in AA than CA subjects (33.7 vs 31.1 years; p = 0.0001).
AA subjects presented with multisite signs and symptoms at disease onset more often than CA subjects (p = 0.018).
Clinical involvement restricted to the Optic Nerves and Spinal Cord (OpticoSpinal MS) occurred in 16.8% of AA patients compared with 7.9% of CA patients (p < 0.001).
Transverse Myelitis also occurred more frequently in AA subjects (28 vs 18%; p = 0.001).
Survival analysis revealed that AA subjects were at higher risk for development of ambulatory disability than CA subjects.
After adjusting for baseline variations and differences in therapeutic interventions, AAs were at 1.67-fold greater risk for requiring a cane to ambulate than CA patients (p < 0.001).
There was a trend suggesting that AAs were also at greater risk for development of wheelchair dependency (p = 0.099).
Adjusted Cox proportional hazard models showed that this effect was in part attributable to the older age at onset in AAs (p < 0.001).
Compared with Multiple Sclerosis (MS) in Caucasian Americans, African American patients with MS have a greater likelihood of developing OpticoSpinal MS and Transverse Myelitis and have a more aggressive disease course.
Kaufman MD, Johnson SK, Moyer D, Bivens J, Norton HJ
Am J Phys Med Rehabil 2003 Aug;82(8):582-90
Multiple Sclerosis Center, Carolinas Medical Center, Charlotte, North Carolina 28223, USA
Although epidemiology indicates that Multiple Sclerosis is more common among whites than African Americans, the course of disease may be more aggressive among African Americans.
This study examines disease course in a large Multiple Sclerosis clinic population.
A case-controlled, retrospective record review compared the severity of Multiple Sclerosis for African Americans and for whites.
Because the baseline demographics of the two groups differed, we performed analyses of multiple subgroups in an attempt to control for various characteristics.
Consistent evidence of more disability in African Americans compared with whites was found, although subgroups were often too small to establish statistical significance.
African Americans had a higher mean Expanded Disability Status Scale score than whites in a subgroup selected to minimize differences in access to care and disease perceptions.
African Americans reported limb weakness as a presenting symptom of Multiple Sclerosis more frequently than did whites. When patients were followed at our Multiple Sclerosis center, rates of disease progression were nearly identical.
More African Americans than whites experience Pyramidal System involvement early in Multiple Sclerosis, leading to greater disability as measured by the ambulation-sensitive Expanded Disability Status Scale.
Once patients have moderate difficulty walking, the rate of progression is the same for both groups, albeit occurring at a later age for whites than for African Americans.
Multiple Sclerosis Characteristics In African American Patients In The New York State Multiple Sclerosis Consortium
New York State Multiple Sclerosis Consortium
Weinstock-Guttman B, Jacobs LD, Brownscheidle CM, Baier M, Rea DF, Apatoff BR, Blitz KM, Coyle PK, Frontera AT, Goodman AD, Gottesman MH, Herbert J, Holub R, Lava NS, Lenihan M, Lusins J, Mihai C, Miller AE, Perel AB, Snyder DH, Bakshi R, Granger CV, Greenberg SJ, Jubelt B, Krupp L, Munschauer FE, Rubin D, Schwid S, Smiroldo J
Mult Scler 2003 Jun;9(3):293-8
The Jacobs Neurological Institute, William C. Baird Multiple Sclerosis Research Center, Buffalo, NY 14203, USA
The objective of this study was to determine the clinical characteristics of Multiple Sclerosis (MS) in African American (AA) patients in the New York State Multiple Sclerosis Consortium (NYSMSC) patient registry.
The NYSMSC is a group of 18 MS centers throughout New York State organized to prospectively assess clinical characteristics of MS patients.
AAs comprise 6% (329) of the total NYSMSC registrants (5602). Demographics, disease course, therapy, and SocioEconomic Status were compared in AA registrants versus NonAfrican Americans (NAA).
There was an increased female preponderance and a significantly younger age at diagnosis in the AA group. AA patients were more likely to have greater disability with increased disease duration.
No differences were seen in types of MS and use of Disease Modifying Therapies. Our findings suggest a racial influence in MS.
Further genetic studies that consider race differences are warranted to elucidate mechanisms of disease susceptibility.