3 "You need to know what to expect in the future."

Some risk factors are well-known and seem almost obvious: White women are at increased risk for osteoporosis. Black Americans are more likely to develop type-2 diabetes; older people are at higher risk for developing OA. But knowing your risk factors and understanding not just what's happening with your arthritis now but in the future is invaluable information you need to best manage your arthritis. Your age, your gender, your family history and your ethnicity can all affect your long-term health.

So why the zipped lips? Doctors may be reluctant to bring up bad-news scenarios about things you can't change, like ethnicity, since they don't want to alarm you with statistics and possibilities that may never occur. Concern that a negative prognosis might make you throw in the towel completely is another factor. Some doctors prefer to operate on a need-to-know basis -- when problems arise, they'll step in. 

But being prepared for the future isn't about accepting your worst-case scenario, it also means you can take steps to prevent it. Osteoporosis and hip fracture rates among black men, for example, are skyrocketing, according to research presented at the American College of Rheumatology Annual Scientific Meeting. For years osteoporosis has not been a concern for black men, but this new information means they can follow the same osteoporosis-preventing measures doctors recommend for white women: getting plenty of calcium and vitamin D and getting regular exercise. Another study at Northwestern University in Chicago, partially funded by the Arthritis Foundation, found that black and Hispanic people are less likely to receive joint replacements than white people with the same overall health and economic status, suggesting a disconnect between doctors and patients. Another disconnect comes when doctors perceive older patients as "too frail" for a new surgery or too old for cutting-edge treatment to make much difference in their overall lifespan, when there is plenty of evidence that suggests otherwise. 

What can you do? Ask your doctor about your prognosis and risk factors. This can be a scary prospect, so consider bringing a supportive friend along for this visit. Say, "I know you can't tell me anything for certain, but I need to know -- where do you think I'll be in 10 years? Is it better or worse that I've gotten arthritis so young?" If you still feel uncomfortable, consider finding a doctor with your same gender, age and ethnicity -- some studies suggest that doctor-patient communication is at its best when doctor and patient share these factors.

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