Racial and ethnic differences can affect the outlook for people living with rheumatoid arthritis (RA). Skin color, socioeconomic differences, and other factors can contribute to misdiagnosis and differences in treatment.

RA is a type of inflammatory arthritis. RA can cause pain and stiffness in the joints, and it can also affect other organs and tissue throughout the body.

Although there is no cure for RA, doctors can prescribe and recommend several different therapies to help ease symptom severity, slow the progression of the disease, and prevent complications.

Advanced treatments would likely benefit anyone with RA, but racial and ethnic differences can affect all aspects of care. These include not only learning about the disease and getting a diagnosis but also which treatment options a doctor recommends.

This article explores the research on differences in RA treatment and care and provides some tips on what steps a person can take to help ensure that they receive care equal to that of others.

Treatment for RA focuses on several related goals, including:

  • reducing pain and swelling
  • preventing joint or organ damage
  • reducing the risk of long-term complications

In the past 30 years, researchers have developed a better understanding of RA and made several improvements to its treatment. Many people respond well to treatment and can even reach remission status, where there are no signs of active disease.

However, evidence shows that racial, ethnic, and socioeconomic factors can reduce the access that certain groups have to care. The following are some of the areas that researchers have identified as being in need of improvement.

Accessibility of educational material

Knowledge can help a person better understand the condition they are living with or realize that the symptoms they have indicate that something may be wrong. Online resources can help a person learn more about a disease.

In a 2020 study, researchers looked at 134 different educational materials for patients that were available online in Spanish. They found that although the documents provided medically accurate information, the majority included various spelling and grammar errors. In most cases, the team classified the readability of articles as “very confusing.”

When a person is seeking to understand their symptoms or diagnosis, it is essential that they have access to accurate, comprehensible information. In this case, translations of patient education materials that are unreadable mean that a person whose primary language is Spanish may not be able to access important information about their condition.

In addition, it is imperative that healthcare professionals receive education on the potential for racial bias and systemic inequalities to affect the standard of care that they offer their patients.

Differences in research participation

According to a 2021 study, proper representation of diverse racial and ethnic groups in RA studies is lacking. The study noted that most studies include low numbers of individuals belonging to historically marginalized populations.

The authors note the need to address disparities at every part of the system to help people of different racial and ethnic groups receive equal care. Government initiatives and researchers are working on identifying barriers of entry to trials and putting strategies in place to overcome them.

Recruiting study participants that better represent the diversity of people that conditions affect can lead to a better understanding of the factors that play a role in diagnosis, treatment, and disease progression.

Differences in prescribed medications

Another area of difference is the medications that doctors prescribe. According to a 2020 study, doctors are more likely to prescribe glucocorticoids than biologics to Black patients and vice versa to white patients.

However, the authors note that geographic differences, as well as the higher prevalence of comorbidities among Black people, may contribute to this disparity. They recommend that additional research focus on finding the reasons for the differences in prescribed medications. Understanding the roles of insurance coverage, out-of-pocket medication costs, and physician trust is important.

Doctors often use biologics for severe cases of RA. These medications can help block the immune system’s response, which can lower inflammation and reduce symptom severity and disease progression.

Increase in complications and hospitalizations

Another area of concern is the number of people who become hospitalized or develop complications due to their underlying condition.

For example, a 2020 study looked at the outcomes of nearly 700 people living with rheumatic disease who received a diagnosis of COVID-19. The results showed that ethnic and racial minority groups had a disproportionately higher risk of hospitalization and invasive ventilation measures for the treatment of COVID-19.

The authors note that this difference highlights a need for the authorities to focus on vulnerable populations during public health emergencies. Other organizations have noted that these differences in outcome are due not to biological differences among these populations but to social determinants of health and systemic racism.

Increased levels of loneliness and isolation

Among People of Color, those living with RA may be more likely to feel lonely and isolated. An ongoing research study notes, “Loneliness and social isolation are common and more pronounced in members of minority communities with rheumatic diseases.” These feelings can lead to poor outcomes and reduced quality of life.

Many of the disparities in healthcare are systemic in nature. In other words, every level of healthcare, from the initial diagnosis to the treatment and follow-up, needs improving when it comes to differences in racial and ethnic backgrounds.

Some of the steps toward addressing these disparities include:

  • educating and diversifying the healthcare professionals treating RA
  • addressing geographic and financial barriers to access
  • providing accessible health information in various languages and formats
  • recruiting and retaining individuals from diverse populations as research participants

Several organizations have taken note of these differences in care for people living with RA and started taking action. A person can help these larger organizations reach their goal of providing better, more equal care for all.

For example, the 50-State Network offers advocates the opportunity to contribute by:

  • helping connect people with research studies to participate in
  • notifying those living with chronic conditions of impending legislation
  • providing opportunities for people to become patient advocates

Self-advocacy refers to the ability of a person to speak up, ask questions, and take a more proactive role in their healthcare. Although a single person might not be able to overcome systemic barriers on their own, self-advocating can help achieve more positive health outcomes.

A person can take steps to self-advocate, including:

  • learning more about their health condition
  • asking questions about their diagnosis, treatment, and outlook
  • confirming the costs of treatments
  • working with a doctor or healthcare professional
  • sharing all medical information with a doctor, even things that may seem unimportant or embarrassing
  • asking for and keeping a hard copy of all medical records

Racial and ethnic disparities in RA treatments can make it more difficult for People of Color and those belonging to other historically marginalized groups to get equal quality healthcare. The differences can affect everything from self-education on the condition to what treatments doctors offer to help with the condition. The results can include a lower quality of care and an increased risk of complications.

Researchers are looking into the reasons why the disparities occur to help people gain equal access to treatment for RA. Organizations and healthcare professionals are also working toward larger, systemic changes. In the meantime, people can join advocacy groups, look for research opportunities, and learn more about being a self-advocate.