Abstract

Racial Disparities in the Medical Management of Rheumatoid Arthritis

Author(s): Jaide Cotton1,2*, Ayana Crawl- Bey1,2, Samrawit Zinabu2 and Miriam Michael2

Background: Rheumatoid arthritis (RA) is a chronic, inflammatory polyarthritis characterized by erosive joint destruction and systemic complications. Early detection and prompt treatment with disease-modifying anti-rheumatic drugs (DMARDs) are essential to mitigate joint damage, prevent disability, and reduce the risk of comorbidities such as cardiovascular disease, osteoporosis, and lymphoma. Prior research has identified significant racial and socioeconomic disparities in RA management, with evidence suggesting that African American patients experience delays in treatment initiation and are under-represented in clinical research compared to their Caucasian counterparts. This study aimed to evaluate treatment utilization disparities between white and Black patients with RA. Methods: We conducted a retrospective cohort study using the TriNetX Global Network, a deidentified electronic health record-based database encompassing approximately 160 million patients from 143 healthcare organizations. RA patients were identified using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes. Two cohorts were defined based on racial identification white and African American and were matched 1:1 using propensity score matching for demographics, comorbidities, and social factors. Baseline data were extracted from the 12 months preceding the index event, and patients were followed for 5 years. The primary outcomes were the proportions of patients prescribed traditional DMARDs, non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, biologic therapies, and interleukin inhibitors, as determined by RxNorm codes. Group differences were evaluated using Z-tests and Kaplan–Meier survival analyses. Results: After matching, each cohort comprised 99,063 patients with comparable demographics (mean age 58.1±15.2 years; ~81% female). While DMARD utilization was similar between white (33.35%) and Black patients (34.45%), notable differences emerged in other treatment modalities. Black patients had higher rates of NSAID (22.70% vs. 16.89%) and corticosteroid (5.56% vs. 4.29%) use, whereas white patients were more likely to receive biologic therapies (13.62% vs. 11.29%) and interleukin inhibitors (2.78% vs. 2.00%). Conclusion: These findings reveal significant racial disparities in RA treatment patterns despite balanced baseline characteristics. The observed differences in therapeutic approaches may contribute to divergent long-term outcomes, underscoring the need for targeted interventions to ensure equitable care across racial groups.