Racial Disparities in the Treatment of Rheumatoid Arthritis

Introduction

Rheumatoid arthritis (RA) is a chronic inflammatory disease associated with joint destruction and systemic complications. Early treatment with disease-modifying antirheumatic drugs (DMARDs) is critical to prevent disability and comorbidities. Prior research identified significant racial and socioeconomic disparities in RA management, suggesting that African American patients experience delays in treatment initiation and underrepresentation in research. This study evaluated treatment utilization disparities between white and Black patients.

Methods

A retrospective cohort study was conducted using the TriNetX Global Network, a database of 160 million patients. RA patients were identified using ICD-10-CM codes and classified into white and African American cohorts, matched 1:1 based on demographics, comorbidities, and social factors. Treatment utilization, including DMARDs, NSAIDs, corticosteroids, biologic therapies, and interleukin inhibitors, was analyzed using RxNorm codes. Group differences were assessed using Z-tests and Kaplan–Meier survival analysis.

Results

DMARD utilization was similar between white (33.35%) and African American (34.45%) patients. However, African American patients had higher NSAID (22.70% vs. 16.89%) and corticosteroid (5.56% vs. 4.29%) use, while white patients were more likely to receive biologic therapies (13.62% vs. 11.29%) and interleukin inhibitors (2.78% vs. 2.00%). White patients were also initiated on biologic and interleukin inhibitor therapies earlier.

Conclusion

This study highlighted important differences in treatment utilization between white and African American patients. These differences in therapeutic approaches appear to contribute to poorer prognosis, accelerated disease progression, and diminished quality of life among African American patients. This emphasizes the need for targeted interventions to promote equitable care.