In this MD Newsline exclusive interview with rheumatologist Dr. Maggie Cadet, we discuss the disparities experienced by minority populations with rheumatoid arthritis. We also discuss the role of socioeconomic status and education in arthritis management and how to rectify rheumatoid arthritis disparities.
Why do African Americans, Hispanic Americans, and American Indians/Alaska Natives experience greater activity limitations from arthritis than Caucasian Americans?
Dr. Maggie Cadet:
“Studies have found that ethnic minority populations are diagnosed with rheumatoid arthritis much later than Caucasian patients. As a result, minority patients are more likely to experience joint destruction, additional organ damage, and fatigue.
The later the diagnosis is made, the greater the delay in treatment, and the greater the functional disability is for the patient. So, early diagnosis and treatment are key to improving rheumatoid arthritis disparities among minority patients.”
How do socioeconomic status and education impact arthritis management?
Dr. Maggie Cadet:
“Minority populations are less likely to enjoy high socioeconomic status and high levels of education. They are also less likely to be started on aggressive treatments such as disease-modifying antirheumatic drugs or biologic therapies when they are first diagnosed. Moreover, they may have to wait several months to start treatment or to receive a diagnosis at all. All of these factors impact each other and result in worse outcomes for minority populations with rheumatoid arthritis.”
How can healthcare providers help rectify rheumatoid arthritis disparities for racial/ethnic minority patients?
Dr. Maggie Cadet:
“I think the first thing we need to do is look at our own implicit biases when we treat our patients. We have to recognize that many minority patients distrust the healthcare system. So, we have to build trust with these patients if we want them to understand the significance of a rheumatoid arthritis diagnosis and the need for aggressive treatment. Without this trust, our patients will not take the medications needed to prevent worsening of their disease.
Moreover, many minority patients do not have access to resources to research their disease and treatment as they would like to do before further engaging in care. So, they may be more likely to believe that rheumatoid arthritis is just a joint disease, and they can get over the pain and other joint symptoms without treatment.
Whereas, we know that rheumatoid arthritis can involve other organs like the heart, lungs, eyes, nervous system, skin, and gastrointestinal system. So many organ systems are involved, and aggressive treatment is needed to prevent morbidity, disability, and mortality.
To help rectify these disparities experienced by minority patients with rheumatoid arthritis, it’s important that providers give these patients as much time as they need to discuss their condition and the risks and benefits of pharmacologic treatment.
The immune system is such a complex system, and autoimmune disease medications come with side effects, so their risks and benefits must be weighed. But ultimately, the benefits outweigh the risks because these drugs work to prevent physical disability and even depression, which is associated with uncontrolled rheumatoid arthritis.
In short, there are so many steps that need to be taken to rectify these disparities, but I think we can start by fostering better patient-physician relationships, recognizing our implicit biases and our patients’ cultural beliefs, and empowering our patients to be active partners in their care.”
Responses have been condensed and lightly edited.