Challenges of caring for homeless patients with rheumatic and musculoskeletal disorders in Los Angeles

Abstract

Homelessness is a public health crisis. Homeless individuals have significantly worse health outcomes than the general population. We have begun examining challenges of caring for homeless patients with rheumatic and musculoskeletal diseases. Difficulties include physical environment, food and financial insecurity, access to healthcare, low health literacy, and comorbid mental illness, and substance abuse. Based on known prevalences of rheumatic and musculoskeletal diseases (RMSDs), we extrapolate that there are thousands of homeless with rheumatoid arthritis (RA), systemic lupus erythematosus, psoriatic arthritis, gout, and osteoarthritis. We present preliminary observations of disparities in the care of homeless patients with RA seen at the Los Angeles County Medical Center of the Keck School of Medicine of the University of Southern California. They tended to be African American males, missed appointments, utilized emergency services frequently, tended not to be on medications, and exhibited severe disease. We reviewed the available literature on homelessness and homeless healthcare to consider what further studies might be helpful and what interventions might improve the care of patients with RMSDs. We identified several aspirational and practical recommendations. These include ensuring access to healthcare for the homeless (indeed for all); reducing disparities through policy, tailored care, and enhanced social services; and recognizing and treating disease early. Developing better approaches for the care of these homeless has obvious and important implications for other underserved populations needing rheumatologic care, patients with early arthritis, or situations where rheumatologists are unavailable. We believe that physicians have a special responsibility to mitigate inequities in this particularly disadvantaged population.

Homelessness: cause and effects

“…Dr. Richard Panush and his team [5], as expected from their profound humanity, social concern, and enlightenment, once again touched my heart and made me think with an essay on rheumatic and musculoskeletal disease care for the homeless. The clinical vignette that opens the discussion describes Mr. C, a homeless man with severe, active rheumatoid arthritis who uses a wheelchair and is out of medications.…”

Challenging issues in rheumatology: thoughts and perspectives

“…Of the 44 requests, we noted incorrect diagnoses and/or unnecessary diagnostic testing in seven of the patients (Table 2). These observations, the study by Hochberg et al [11], and our recent report in this journal about homeless rheumatoid arthritis patients [13] all illustrate how crucial it is to provide quality care-doing the right thing in the right way at the right time for the right patient, always-for all patients.…”

Clinical features and risk factors of Raynaud’s phenomenon in primary Sjögren’s syndrome

“…Additionally, based on previous studies, pSS patients with positive ACA were regarded as a distinct clinical subgroup, showing intermediate features on classical pSS and limited cutaneous scleroderma (lSSc) [34]. Furthermore, Miyawaki et al [35] reported that 6 out of 10 (60%) pSS patients with ACA and RP developed CREST syndrome in the long follow-up investigation, and it is necessary for us to follow up the present ACA-positive pSS-RP patients to determine whether they develop CREST syndrome in the long run.…”