Reconsidering Race-Based Medicine in Pediatric Rheumatology: Challenges and Opportunities for Equitable Care.

Abstract

Despite growing evidence of their limitations, race-based practices in pediatric rheumatology-those that rely on race or ethnicity to influence diagnosis and treatment-continue to shape care, often reinforcing health disparities. The assumption that biological or genetic differences exist between racial groups oversimplifies complex health issues and perpetuates health inequities. This paper examines persistent race-based practices in pediatric rheumatology, particularly in the interpretation of laboratory results and clinical decision-making, and highlights their clinical limitations. For example, the use of race-adjusted formulas in estimating glomerular filtration rate (eGFR), pulmonary function tests, and creatine kinase levels can lead to misdiagnoses and delayed interventions, particularly in Black and Asian populations. Additionally, race-based assumptions in diseases like Kawasaki disease and multisystem inflammatory syndrome in children (MIS-C) can lead to incorrect conclusions about disease severity and treatment efficacy. This article advocates for a shift toward race-conscious practices that consider the role of social determinants of health and biases in clinical care. It also emphasizes the need for more inclusive research methodologies and diverse representation in clinical trials to enhance the generalizability of findings. By moving away from race-based practices and adopting equity-oriented frameworks, pediatric rheumatologists can better address the needs of marginalized populations and improve health outcomes. This shift is crucial in dismantling systemic disparities and advancing health equity in clinical and research settings.