"He lifts 50-pound barrels. He said he could tell his [boss] he could do lighter work, but he couldn’t go three months not lifting anything,” Dr. Zikria says. "They still make him lift 25 pounds. It’s tough out there.”

Dr. Crofford says many of her patients with chronic diseases in rural Kentucky who have physically demanding jobs in areas like manufacturing have been afraid to even ask for adjustments in their job duties because they worry it will get them fired.

“There are incidents where repetitive motion or the kinds of work they are doing are aggravating their condition and in good times people would say – ‘hey, could you write me a letter asking me to be reassigned so I’m not doing something that say aggravates my shoulder,’” Dr. Crofford explains. "But now people don’t want to do that because they are afraid of getting laid off. So there are many ways that fear of the economy affects patients and their rheumatic diseases,” she says.

“This is as bad as I’ve ever seen it over the last 25 years,” Dr. Crofford continues. “It’s just very noticeable and very pervasive.”

Stress Takes a Toll on Children

Dr. Lovell says that financial anxiety isn’t just affecting adults. He says some children he sees haven’t been telling their parents when their symptoms worsen because they are worried about how their disease is affecting their family’s financial health.

“Some of them are, I think, quietly internalizing their concerns about how extra doctor visits, extra lab visits may impact the budget,” Dr. Lovell says. “You see elementary aged kids thinking about this. So it's going down to a younger age group that’s thinking about this and wondering what the impact of their disease has on the family.”

Dr. Lovell says some of his young patients are also expressing resistance to new treatments and when he probes into the reason, they talk about the cost.

“Many times it’s younger kids who really don’t understand the role of insurance. So when you talk about a biologic cost of $15,000 a year, a little child can sense that’s a lot of money, but what they don’t understand is that insurance can pay for a large proportion of that,” he says.

“So the kid’s thinking this is a $15,000 hit on the family budget when they are seeing their parents struggle with $100 or $200 charges," says Dr. Lovell.