Newswise – ATLANTA – New research presented this week at ACR Convergence, the annual meeting of the American College of Rheumatology, found that racial and ethnic disparities for disease activity persist in people with rheumatoid arthritis. Black and Hispanic patients often had higher disease activity and lower self-reported functional status compared to white patients. (Abstract # 0604).
Rheumatoid arthritis (RA) is the most common type of autoimmune arthritis. It is caused when the immune system (the body’s defense system) is not working properly. RA causes pain and swelling in the wrist and the small joints of the hands and feet. Sometimes RA can cause a variety of systemic effects, such as severe fatigue or organ damage to the heart, lungs or eyes.
Research has shown that there are differences in disease activity and clinical outcomes for people with RA across different racial and ethnic groups in the United States. The authors conducted this new study to learn more about these disparities and how they may have changed over time.
âDisparities exist in the healthcare system, and these inequalities impact both patient experience as well as patient clinical outcomes,â says Jacqueline O’Brien, PhD, clinical epidemiologist at CorEvitas, LLC, and co-author of the study. âHowever, this has not been studied as extensively in RA as in other disease areas, so there is still a need to understand the magnitude of the health disparities in RA. We need to identify where they exist. disparities, so we can better target therapy and improve care, for all patients. â
The researchers used data from the CorEvitas registry of more than 56,000 RA patients living in 42 US states. They included patients who had clinic visits between 2013 and 2015 and 2018 and 2020. Patients reported their race and ethnicity and were grouped into black (non-Hispanic), white (non-Hispanic), Hispanic, or Asian. The Clinical Disease Activity Index (CDAI) was used at both visits to measure RA activity.
There were 9,363 participants, mostly women and in their late 50s, including 8,142 white, 527 black, 545 Hispanic and 149 Asian. The duration of their RA disease ranged from about 10 to 12 years. More than half of the patients had a history of serious infections. Up to 41% had a history of hypertension.
The primary outcome of the study was the clinical disease activity index score. Secondary outcomes were the proportion of patients with low activity or disease remission and the HAQ disability index, a measure of physical function, at each visit. In addition to looking at the results cross-sectionally, the researchers assessed the mean change in disease activity and physical function scores from the first to the second visit, and the likelihood of patients achieving low blood activity. disease or remission by the second visit.
The estimated clinical disease activity index remained significantly higher, meaning greater disease activity, for Hispanic patients compared to white patients at both time points. Disease activity improved over the 7-year study period among all racial and ethnic groups, although Hispanic patients improved less than white patients. There were differences in functional status at the two time points, with black and Hispanic patients having higher scores, meaning more severe functional impairment, compared to white patients. Racial and ethnic groups achieved low disease activity and remission at similar rates between the two periods.
âOur study was designed to assess clinical outcomes and, unfortunately, does not address issues related to access to care. We saw that all patients demonstrated improvement over time, but even after adjusting for potential confounding variables, such as study site, past and current biological use, insurance status, l ‘Education, there were still differences between racial and ethnic groups at the second point, “says O’Brien. âMany factors contribute to health inequality, including access to care, socioeconomic status, systemic racism and other social determinants of health. Certainly, more research is needed to understand how these factors interact and lead to different clinical outcomes for racial and ethnic groups. “
Author’s Note: This study was funded by Bristol Myers Squibb. None of the reviews focused on the therapies manufactured by the company or would impact the prescription of their products.
About ACR Convergence
ACR Convergence, the annual meeting of the American College of Rheumatology, is where rheumatology comes together to collaborate, celebrate, come together and learn. With over 320 sessions and thousands of abstracts, it offers a superior combination of basic science, clinical science, business training and interactive discussions to improve patient care. For more information on the meeting, visit https://www.rheumatology.org/Annual-Meeting, or join the conversation on Twitter by following the official hashtag (# ACR21).
About the American College of Rheumatology
Founded in 1934, the American College of Rheumatology (ACR) is a nonprofit professional association committed to advancing the specialty of rheumatology that serves more than 7,700 physicians, healthcare professionals and scientists worldwide. In doing so, the CAB provides educational, research, advocacy and practice management support to help its members continue their innovative work and provide quality patient care. Rheumatology professionals are experts in the diagnosis, management and treatment of over 100 different types of arthritis and rheumatic diseases. For more information, visit www.rhumatologie.org.