Life challenges prevent those with lupus from keeping doctors' appointments

http://www.eurekalert.org/pub_releases/2011-11/hfss-lcp110411.php

Public release date: 5-Nov-2011
Contact: Phyllis Fisher
Hospital for Special Surgery
Transportation and childcare difficulties top reasons for missed appointments

The first step towards successful medical care is to see a physician, but for some patients this isn't as simple or easy as it may sound.

A study being presented Sunday, Nov. 6 at the 2011 Annual Scientific Meeting of the American College of Rheumatology in Chicago, finds that many lupus patients with low socioeconomic status are unable to attend scheduled appointments with physicians due to daily obstacles.

"Lupus is a systemic autoimmune disease that requires continuous monitoring of the disease activity and the effects medications may be having on someone," explained Doruk Erkan, M.D., senior author, rheumatologist and clinical co-director at the Mary Kirkland Center for Lupus Care at Hospital for Special Surgery. "Missing an appointment, and thus staying on a medical course without re-evaluating a patient's health status, could cause these individuals avoidable harm."

The researchers examined lupus patients who also had low socioeconomic status at the Mary Kirkland Center for Lupus Care at Hospital for Special Surgery, and found that challenges of socioeconomic status played a large part in causing some of the patients to miss their appointments. The top two reasons for missing their appointment was due to tardy or unreliable transportation, such as ambulettes, or because of insufficient childcare.

"Most of these lupus patients are women," explained Pretima Persad, MPH, lead author of the study and the manager of the Mary Kirkland Center for Lupus Care. "If their childcare falls through, they put their child first and decide to cancel appointments, which can then affect their healthcare."

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A common and potentially dangerous health concern for these individuals is kidney inflammation, because, in lupus patients, the body's own immune system may attack different organs including kidneys. If not monitored regularly, someone with lupus might be faced with kidney malfunction without experiencing any pain. Regular urine and blood testing, at least every three months in patients who are deemed by their rheumatologist to have relatively active lupus, is important to monitor kidney involvement, explained Kyriakos A. Kirou, M.D., DSc, FAC, co-author of the study and clinical co-director at the Mary Kirkland Center for Lupus Care at Hospital for Special Surgery.

"It's possible that these patients are doing fine, but it's also possible that they are getting sick internally, without having any significant symptoms," explained Dr. Kirou. "They could be in dire need of medical attention without knowing it."

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