Background/Purpose: Homelessness is a public health crisis. Those with housing insecurity have unique barriers to healthcare that confound their outcomes. Because of the paucity of data about rheumatic disease patients (pts) with housing insecurity, we sought to better understand these challenges and develop approaches to improve their care.

As rheumatologists and “street medicine” providers, we identified homeless pts with rheumatic diseases to improve management and outcomes, reflecting responsibilities to promote social justice and equitable healthcare. We previously reported observations on 17 pts with inflammatory arthritis (15 rheumatoid arthritis [RA], 2 psoriatic arthritis [PsA]) (Clin Rheum 40:413-20, 2021). Here, we provide follow up on our pts and their perspectives on barriers to care.

Methods: We obtained follow-up clinical information from our original 17 pts and compared this to data summarized and published about them from 12 months previously. We also created a 100-question survey to assess pts’ challenges and needs.

Results: Follow-up 12-month clinical information was available from 13/17 homeless (H) and 13/17 randomized, non-homeless (NH), controls. H were 54% and NH 92% female; H mean age was 57 (±9) and NH 61 (±8) years old; H 38% and NH 31% African American; H 38% and NH 23% Latino; and H 15% and NH 8% Caucasian.

H remained less well with more disease than NH– poorer clinic appointment compliance (80% vs 91%, p< 0.05), more emergency services use (20 vs 5 ED visits), less use of DMARDs (43% vs 100%, p< 0.01), more steroid use (29% vs 0%, p< 0.01), and higher inflammatory markers (ESR 32 vs 26 mm/hr and CRP 17 vs 5 mg/L). 78% of H were assessed as stable, 14% improved, and 7% worse; 21% had stable controlled and 57% stable active disease vs 62% and 0% in NH (p< 0.01).

Among the H, 6 (4 RA, 2 PsA) completed the survey, 2 declined, and 9 could not to be reached. All 6 had found housing although all still had housing insecurity; 4 (67%) were homeless in the past. 3/6 (50%) obtained housing from social assistance during hospitalization following disease exacerbation while homeless. Average monthly income was $873. 5/6 (83.3%) were unable to work due to health and were in considerable pain that adversely impacted their physical and mental health and ability to perform ADLs. Their perceived “greatest need” included dental care, physical therapy, knee surgery, employment, socialization secondary to isolation, and stable housing.

Conclusion: These observations, while limited to modest numbers of pts and difficulties sustaining contact, add to our understanding of the unique challenges of homeless pts and provide a framework for strengthening collaboration between “street medicine” and rheumatology care providers to improve treatment and outcomes. This is supported by the fact that half of surveyed pts obtained housing following hospitalization while homeless. Moreover, pts’ perceived “greatest needs” went beyond housing and rheumatological care and indicate the importance of access to social and specialty services (ie, mental health, physical therapy, dental care, and employment). Collectively, these data suggest exciting opportunities to offer our homeless pts better quality and more equitable care.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/challenges-of-caring-for-patients-with-inflammatory-arthritis-experiencing-homelessness-preliminary-12-month-follow-up-observations-and-identification-of-certain-barriers-to-care/