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Racial and Ethnic Disparities in Disease Activity in Patients with Rheumatoid Arthritis

      Abstract

      Background

      Observational studies of patients with rheumatoid arthritis have suggested that racial and ethnic disparities exist for minority populations. We compared disease activity and clinical outcomes across racial and ethnic groups using data from a large, contemporary US registry.

      Methods

      We analyzed data from 2 time periods (2005-2007 and 2010-2012). The Clinical Disease Activity Index was examined as both a continuous measure and a dichotomous measure of disease activity states. Outcomes were compared in a series of cross-sectional and longitudinal multivariable regression models.

      Results

      For 2005-2007, significant differences of mean disease activity level (P < .001) were observed across racial and ethnic groups. Over the 5-year period, modest improvements in disease activity were observed across all groups, including whites (3.7; 95% confidence interval [CI], 3.2-4.1) compared with African Americans (4.3; 95% CI, 2.7-5.8) and Hispanics (2.7; 95% CI, 1.2-4.3). For 2010-2012, significant differences of mean disease activity level persisted (P < .046) across racial and ethnic groups, ranging from 11.6 (95% CI, 10.4-12.8) in Hispanics to 10.7 (95% CI, 9.6-11.7) in whites. Remission rates remained significantly different across racial/ethnic groups across all models for 2010-2012, ranging from 22.7 (95% CI, 19.5-25.8) in African Americans to 27.4 (95% CI, 24.9-29.8) in whites.

      Conclusions

      Despite improvements in disease activity across racial and ethnic groups over a 5-year period, disparities persist in disease activity and clinical outcomes for minority groups versus white patients.

      Keywords

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      References

        • Gabriel S.E.
        The epidemiology of rheumatoid arthritis.
        Rheum Dis Clin North Am. 2001; 27: 269-281
        • Wolfe F.
        • Michaud K.
        • Gefeller O.
        • Choi H.K.
        Predicting mortality in patients with rheumatoid arthritis.
        Arthritis Rheum. 2003; 48: 1530-1542
        • Birnbaum H.
        • Pike C.
        • Kaufman R.
        • Marynchenko M.
        • Kidolezi Y.
        • Cifaldi M.
        Societal cost of rheumatoid arthritis patients in the US.
        Curr Med Res Opin. 2010; 26: 77-90
        • Saag K.G.
        • Teng G.G.
        • Patkar N.M.
        • et al.
        American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease-modifying antirheumatic drugs in rheumatoid arthritis.
        Arthritis Rheum. 2008; 59: 762-784
        • Singh J.A.
        • Furst D.E.
        • Bharat A.
        • et al.
        2012 update of the 2008 American College of Rheumatology recommendations for the use of disease-modifying antirheumatic drugs and biologic agents in the treatment of rheumatoid arthritis.
        Arthritis Care Res (Hoboken). 2012; 64: 625-639
        • Smolen J.S.
        • Landewe R.
        • Breedveld F.C.
        • et al.
        EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs.
        Ann Rheum Dis. 2010; 69: 964-975
        • Smolen J.S.
        • Aletaha D.
        • Bijlsma J.W.
        • et al.
        Treating rheumatoid arthritis to target: recommendations of an international task force.
        Ann Rheum Dis. 2010; 69: 631-637
        • Yazici Y.
        • Kautiainen H.
        • Sokka T.
        Differences in clinical status measures in different ethnic/racial groups with early rheumatoid arthritis: implications for interpretation of clinical trial data.
        J Rheumatol. 2007; 34: 311-315
        • Bruce B.
        • Fries J.F.
        • Murtagh K.N.
        Health status disparities in ethnic minority patients with rheumatoid arthritis: a cross-sectional study.
        J Rheumatol. 2007; 34: 1475-1479
        • Barton J.L.
        • Trupin L.
        • Schillinger D.
        • et al.
        Racial and ethnic disparities in disease activity and function among persons with rheumatoid arthritis from university-affiliated clinics.
        Arthritis Care Res (Hoboken). 2011; 63: 1238-1246
        • Iren U.T.
        • Walker M.S.
        • Hochman E.
        • Brasington R.
        A pilot study to determine whether disability and disease activity are different in African-American and Caucasian patients with rheumatoid arthritis in St. Louis, Missouri, USA.
        J Rheumatol. 2005; 32: 602-608
        • Zerhouni E.
        Medicine. The NIH Roadmap.
        Science. 2003; 302: 63-72
        • Kremer J.
        The CORRONA database.
        Ann Rheum Dis. 2005; 64: iv37-iv41
        • Kremer J.M.
        The CORRONA database.
        Autoimmun Rev. 2006; 5: 46-54
        • Aletaha D.
        • Nell V.P.
        • Stamm T.
        • et al.
        Acute phase reactants add little to composite disease activity indices for rheumatoid arthritis: validation of a clinical activity score.
        Arthritis Res Ther. 2005; 7: R796-R806
        • Aletaha D.
        • Smolen J.
        The Simplified Disease Activity Index (SDAI) and the Clinical Disease Activity Index (CDAI): a review of their usefulness and validity in rheumatoid arthritis.
        Clin Exp Rheumatol. 2005; 23: S100-S108
        • Callahan L.F.
        • Pincus T.
        • Huston 3rd, J.W.
        • Brooks R.H.
        • Nance Jr., E.P.
        • Kaye J.J.
        Measures of activity and damage in rheumatoid arthritis: depiction of changes and prediction of mortality over five years.
        Arthritis Care Res. 1997; 10: 381-394
        • Geller S.E.
        • Adams M.G.
        • Carnes M.
        Adherence to federal guidelines for reporting of sex and race/ethnicity in clinical trials.
        J Womens Health (Larchmt). 2006; 15: 1123-1131
        • Cannon G.W.
        • Mikuls T.R.
        • Hayden C.L.
        • et al.
        Merging Veterans Affairs rheumatoid arthritis registry and pharmacy data to assess methotrexate adherence and disease activity in clinical practice.
        Arthritis Care Res (Hoboken). 2011; 63: 1680-1690
        • Constantinescu F.
        • Goucher S.
        • Weinstein A.
        • Fraenkel L.
        Racial disparities in treatment preferences for rheumatoid arthritis.
        Med Care. 2009; 47: 350-355
        • Constantinescu F.
        • Goucher S.
        • Weinstein A.
        • Smith W.
        • Fraenkel L.
        Understanding why rheumatoid arthritis patient treatment preferences differ by race.
        Arthritis Rheum. 2009; 61: 413-418
        • Kurreeman F.
        • Liao K.
        • Chibnik L.
        • et al.
        Genetic basis of autoantibody positive and negative rheumatoid arthritis risk in a multi-ethnic cohort derived from electronic health records.
        Am J Hum Genet. 2011; 88: 57-69
        • Kochi Y.
        • Suzuki A.
        • Yamada R.
        • Yamamoto K.
        Ethnogenetic heterogeneity of rheumatoid arthritis-implications for pathogenesis.
        Nat Rev Rheumatol. 2010; 6: 290-295
        • Teller K.
        • Budhai L.
        • Zhang M.
        • Haramati N.
        • Keiser H.D.
        • Davidson A.
        HLA-DRB1 and DQB typing of Hispanic American patients with rheumatoid arthritis: the “shared epitope” hypothesis may not apply.
        J Rheumatol. 1996; 23: 1363-1368
        • Perkins E.A.
        • Landis D.
        • Causey Z.L.
        • et al.
        Association of single-nucleotide polymorphisms in CCR6, TAGAP, and TNFAIP3 with rheumatoid arthritis in African Americans.
        Arthritis Rheum. 2012; 64: 1355-1358
        • Lundberg K.
        • Bengtsson C.
        • Kharlamova N.
        • et al.
        Genetic and environmental determinants for disease risk in subsets of rheumatoid arthritis defined by the anticitrullinated protein/peptide antibody fine specificity profile.
        Ann Rheum Dis. 2013; 72: 652-658