Disparities in rheumatoid arthritis outcomes for North American Indigenous populations

Abstract

Advances in rheumatoid arthritis (RA) management have significantly improved clinical outcomes of this disease; however, some Indigenous North Americans (INA) with RA have not achieved the high rates of treatment success observed in other populations. We review factors contributing to poor long-term outcomes for INA with RA. We conducted a narrative review of studies evaluating RA in INA supplemented with regional administrative health and clinical cohort data on clinical outcomes and health care utilisation. We discuss factors related to conducting research in INA populations including studies of RA prevention. NA with RA have a high burden of genetic and environmental predisposing risk factors that may impact disease phenotype, delayed or limited access to rheumatology care and advanced therapy. These factors may contribute to the observed increased rates of persistent synovitis, premature end-stage joint damage and mortality. Novel models of care delivery that are culturally sensitive and address challenges associated with providing speciality care to patients residing in remote communities with limited accessibility are needed. Progress in establishing respectful research partnerships with INA communities has created a foundation for ongoing initiatives to address care gaps including those aimed at RA prevention. This review highlights some of the challenges of diagnosing, treating, and ultimately perhaps preventing, RA in INA populations.

Keywords: Rheumatoid arthritis; disparities; indigenous; outcomes; phenotype; prevention.

Figure 1.

Mortality in Indigenous North Americans and non-Indigenous North Americans with or without rheumatoid arthritis in provincial administrative health records data from January 1990 to December 2010. a) Age and sex-adjusted mortality; b) age sex and mCCI-adjusted mortality; c) mortality rate ratio (MRR) for RA comparing Indigenous North Americans (INA) versus non-Indigenous North Americans (nonINA). d) Age at death for incident rheumatoid arthritis. e) Survival curve (for incident RA). RA = rheumatoid arthritis; mCCI = modified Charlson comorbidity index (modified for use with Manitoba administrative data); INA = Indigenous North Americans; nonINA = non-Indigenous North Americans. Black bars mortality rate ratio adjusted for age, sex and mCCI. Grey bars mortality rate adjusted for age and sex.