Multiple sclerosis (MS) is a potentially disabling disease where the immune system attacks myelin in the central nervous system (spinal cord, brain, and optic nerve).

Myelin is the fatty substance that surrounds nerve fibers. This attack causes inflammation, triggering a variety of neurological symptoms.

MS can affect anyone, but it historically was considered more prevalent among white females. Some newer research is challenging the assumptions that other groups are less affected.

Although the disease has been known to appear in all racial and ethnic groups, it often presents itself differently in people of color, sometimes complicating diagnosis and treatment.

MS causes a range of physical and emotional symptoms, including:

  • fatigue
  • numbness or tingling
  • vision problems
  • dizziness
  • cognitive changes
  • pain
  • depression
  • speech problems
  • seizures
  • weakness

But while these common symptoms affect most people with MS, some groups of people — more specifically people of color — can experience more severe or localized forms of the disease.

In a 2016 study, researchers sought to compare patients who were asked to self-identify as African American, Hispanic American, or Caucasian American. They found that on a scale from 0 to 10, the MS severity score for African American and Hispanic American patients was higher than that of Caucasian American patients.

This echoes prior research from 2010 that observed African American patients had higher scores on a severity scale than white American patients, even when adjusting for factors like age, gender, and treatment. This could possibly lead to more motor impairment, fatigue, and other debilitating symptoms.

Other research notes that African Americans are also more likely to have frequent relapses and faster progression of the disease, putting them at increased risk for disability.

Similarly, a 2018 study in which patients were asked to self-identify as either African American or Caucasian American found that atrophy in brain tissue occurred faster in African Americans with MS. This is the gradual loss of brain cells.

According to this study, African Americans lost gray brain matter at a rate of 0.9 percent per year, and white brain matter at a rate of 0.7 percent per year.

The Caucasian Americans (those with self-identified Northern European ancestry), on the other hand, lost 0.5 percent and 0.3 percent of gray and white brain matter per year, respectively.

African Americans with MS also experience more balance, coordination, and walking problems, compared with other populations.

But symptoms aren’t only different for African Americans, though. It’s also different for other persons of color, such as Asian Americans or Hispanic Americans.

Like African Americans, Hispanic Americans are more likely to experience a severe disease progression.

Additionally, some research on phenotypes indicates those with African or Asian ancestry are more likely to have a type of MS known as opticospinal.

This is when the disease specifically affects the optic nerves and spinal cord. This can trigger vision problems, as well as problems with mobility.

Are there reasons for differences in symptoms?

The reason for differences in symptoms isn’t known, but scientists believe genetics and environment might play a role.

One theory suggests a vitamin D link, as a deficiency has been linked to a higher risk for MS. Vitamin D helps the body absorb calcium, and contributes to healthy immune function, bones, muscles, and heart.

Exposure to the sun’s ultraviolet light is a natural source of vitamin D, yet it is harder for darker skin to absorb enough sunlight.

But while a vitamin D deficiency might contribute to MS severity, researchers have only found a link between higher levels and a lower risk of disease in those who are white.

No association has been found between African Americans, Asian Americans, or Hispanic Americans, prompting the need for follow-up studies.

Is there a difference in the onset of symptoms?

The difference doesn’t only apply to symptoms — it also applies to the onset of symptoms.

The average onset of MS symptoms is between the ages of 20 and 50.

But according to research, symptoms may develop later for African Americans, and earlier for Hispanic Americans (about 3 to 5 years earlier), compared with non-Hispanic white Americans.

People of color also face challenges when seeking a diagnosis.

MS is historically believed to primarily affect those who are white. As a result, some people of color live with the disease and symptoms for years before getting an accurate diagnosis.

There’s also the risk of being misdiagnosed with a condition that causes similar symptoms, especially those more prevalent in people of color.

Conditions sometimes mistaken for MS include lupus, arthritis, fibromyalgia, and sarcoidosis.

According to the Lupus Foundation of America, this disease is more prevalent in women of color, including those who are African American, Hispanic, Native American, or Asian.

Also, arthritis appears to affect more people who are Black and Hispanic than those who are white.

But an MS diagnosis doesn’t only take longer because it’s harder to identify.

It also takes longer because some historically marginalized groups don’t have easy access to medical care. The reasons vary but might include lower levels of health insurance coverage, being uninsured, or receiving lower quality of care.

It’s also important to recognize the limitations resulting from a lack of culturally competent care that is free from bias due to systemic racism.

This can all result in inadequate testing and delayed diagnosis.

There’s no cure for MS, although treatment can slow disease progression and lead to remission. This is a period characterized by no symptoms.

First-line therapies for MS often include anti-inflammatory medication and immunosuppressant drugs to suppress the immune system, as well as disease-modifying drugs to stop inflammation. These help slow the progression of the disease.

But although these are standard courses of treatment for the disease, not all racial and ethnic groups respond the same to treatment. Past research has found that for some African Americans, response to disease-modifying therapies may not be as favorable.

The reason is unknown, but some researchers point out disparities in the number of African Americans participating in MS clinical trials.

In research from 2015 it was observed that of the 60,000 articles related to MS available through PubMed in 2014, only 113 focused on African American and Black populations and only 23 on Hispanic American and Latino populations.

Currently, the level of participation by racial and ethnic minorities is still low, and understanding how treatments affect these individuals will require changes to enrollment practices and study recruitment.

The quality or level of treatment can also affect prognosis. Unfortunately, disease progression might also be worse in some populations because of systemic barriers in access to high quality care among Black and Latino patients.

In addition, some people of color might not have access to or be referred to a neurologist for MS treatment, and as a result, they might not receive access to as many disease-modifying therapies or alternative therapies, which could reduce disability.

Multiple sclerosis is a potentially disabling, lifelong condition that attacks the central nervous system. With early diagnosis and treatment, it’s possible to achieve remission and enjoy a higher quality of life.

The disease can present itself differently in people of color, though. So it’s important to recognize how MS may affect you, and then seek competent medical care at the first sign of illness.

Read this article in Spanish.