Physicians are starting to understand that a person’s ethnicity can affect how they experience multiple sclerosis. And there are a few differences between how the disease tends to appear in Latino patients and those of Caucasian descent.
Augusto Miravalle, MD, FAAN, a neurologist at RUSH, specializes in treating patients with MS and offers care in both English and Spanish. He hopes that raising awareness of these differences and the symptoms of the disease will encourage Latinos to seek treatment and, hopefully, improve their outcomes.
“Latinos have a lower incidence of multiple sclerosis. It's not as high as what we see in Caucasians,” Miravalle says. “The highest is white Caucasians of northern European descent. But Latinos tend to have worse prognoses and outcomes.”
So even though Latinos may not be as likely to get MS as Caucasians, they often have more severe symptoms and disabilities from the disease.
Researchers don’t know for sure what causes MS in patients, regardless of their ethnicity. But there are a few reasons that MS is often worse for Latinos.
What doctors know and don’t know about MS
While not directly related to ethnicity, research shows that genes can increase a person’s risk for MS. “Up to 10% of patients with MS have a first-degree relative with the disease,” Miravalle says.
Research also shows that the Epstein-Barr virus, the virus that causes mononucleosis, plays a role. And vitamin D deficiency and smoking can increase the risk of developing MS.
MS happens when the body’s immune system attacks its own central nervous system, disrupting messages between the brain and body. It damages myelin, the protective layer of protein and fatty substances around nerves. Lesions left in the myelin cause inflammation, and that’s when symptoms appear.
How is MS biologically different for Latinos?
Some MS patients live most of their lives without any major symptoms. Others have loss of vision and coordination, mood changes, fatigue or even paralysis.
The symptoms of MS depend on which nerves are damaged and which of the brain’s signals get interrupted. That’s one of the reasons symptoms can vary so much from person to person — and it’s why they can be different for Latinos and Caucasians.
In Latinos with MS, lesions are more likely to develop in the spinal cord and the lower brainstem than they are in Caucasians. The location of these lesions affects which nerves get damaged and which symptoms appear.
“Lesions there tend to affect the pathways in the brain and spinal cord and often lead to more disability,” Miravalle says. “So the location of lesions matters. Sometimes patients can have only one or two lesions. But in the wrong places, they cause more disability than having 20 or 30 lesions in other places.”
Optic neuritis, a symptom of MS, happens when swelling damages the optic nerve, which can lead to loss of vision in one or both eyes and pain when moving the eyes. It’s more common in Caucasian patients.
But transverse myelitis, another MS symptom, is more common in Latino patients. It happens when part of the spinal cord becomes inflamed. This can lead to weakness or numbness in the legs and problems walking.
Problems in the spinal cord from MS are also more common in Latino men than women. It’s not exactly clear why.
But it goes deeper than biology
The reasons Latinos have worse symptoms and outcomes from MS go beyond the biological differences in how the disease appears. Social, economic and cultural factors make it more difficult for them to get treatment.
In the United States, Caucasians generally have better access to proper medical care, including preventive care. According to the U.S. Department of Health and Human Services, Latinos are over twice as likely as Caucasians to be uninsured. This is partly because Latinos are more likely to end up with low-wage jobs, and their employers often don’t offer insurance.
Low income can create a barrier to health care too. The cost of hospital bills may discourage some from seeking treatment because of the financial toll it can take on themselves and their families.
Latinos may also face language barriers, especially if English is not their first language. This can make it harder for them to find a usual source of medical care. Having a regular source of care is important for disease prevention and managing chronic conditions.
All of those factors mean that Caucasians are more likely to get effective treatment — and get it earlier, which can slow the progression of disease.
Culture and fatigue
One of the most common symptoms of MS in patients of any ethnicity is fatigue. Many people might ignore fatigue when they first start to feel tired. Some delay going to the doctor for years until it becomes severe or other problems start to appear.
Cultural factors can make that delay in treatment even worse for Latinos, especially men.
“Latino males, culturally, usually don't like to accept the fact that they might be tired because they're usually the breadwinners of their families,” Miravalle says. “They may have multiple jobs. They don’t complain that they're tired and fatigued. So MS is usually underreported.”
Being the only source of income in a family can create more pressure to keep working, even through extreme fatigue. But the disability that MS can cause may stop a person from being able to work at all.
MS is more common than you might think. It affects one in every 300 to 500 people. No matter your ethnicity, it’s important to see a doctor right away if you start to feel fatigued because it can be an early sign.
While there is no cure for MS, getting treatment early can prevent the disease from quickly getting worse and prevent disability.
“I think we need to highlight the fact that fatigue is a symptom of MS — that if someone is tired to the point of interfering with their usual functions, they need to seek attention,” Miravalle says.