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Does Race Influence Arthritis Treatment? Black Arthritis Patients Get Fewer Biologic DMARDs

rheumatoid arthritis treatment black patients

Are black patients given a raw deal when it comes to treatment for rheumatoid arthritis?

A new study in California shows that if you’re black and have rheumatoid arthritis you’re less likely than your white counterparts to be taking biologic disease-modifying anti-rheumatic drugs (DMARDs). The reasons behind this racial disparity in healthcare are likely to be multifactorial, according to the researchers at the Southern California Permanente Medical Group in Pasadena, but some health advocates are worried that discrimination is compromising black patients’ treatment for rheumatoid arthritis.

This disparity could then leave sufferers with severe neck pain, back pain, and other symptoms of the autoimmune condition, as well as increasing the likelihood of unchecked joint degeneration leading to spinal stenosis.

Fewer Black Patients Taking Stronger RA Medications

Biologic DMARDs are powerful drugs that can significantly reduce the symptoms of rheumatoid arthritis, such as fatigue, fever, and joint pain, but this efficacy comes with a cost. Standard DMARDs cost a few hundred dollars a year while the more powerful drugs can range from $15,000 to $25,000 each year, although both types of rheumatoid arthritis medications are covered by Medicaid with prior approval. The patients assessed during this study were all on Medicaid, meaning that cost did not seem to be a relevant factor in the access to biologic DMARDs for the black patients. Instead, the reasons behind just 9% of black patients taking such drugs, compared to 16% of the white patients, even when the rheumatoid arthritis was as severe, may be connected to cultural values, individual physicians, and timing of treatment.

Treatment Disparity in Rheumatoid Arthritis Sufferers

Some biologics for rheumatoid arthritis have a specific window of opportunity in which the most benefit can be gained from taking the medications to slow down joint degeneration, reduce inflammation, and reduce the severity of neck pain, back pain, and joint pain. The lower use of biologic DMARDs by black patients may be connected to a reluctance to seek medical attention at the early stages of the disease, or poor access to physicians experienced with the drugs. Specialist physicians who are better at managing rheumatoid arthritis may not be readily available in some communities in the US and cultural beliefs were noted as a possible barrier to accessing immediate care during the study.

DMARDs for Rheumatoid Arthritis

Some 5,385 patients with rheumatoid arthritis were analyzed during the study, with most patients in their fifties or sixties and all treated with at least one anti-rheumatic drug between 1998 and 2005 in California. Biologic DMARDs, such as etanercept (Enbrel), anakinra, infliximab, and adalimumab (Humira), were actually more likely to be taken by Hispanic patients than any other ethnic group, according to the data. Some 20% of Hispanics with rheumatoid arthritis were on biologic disease-modifying anti-rheumatic drugs, with others taking standard DMARDs, such as methotrexate (Rheumatrex), hydroxychloroquine, sulfasalazine, and leflunomide (Arava). The severity of disease did differ between blacks, Hispanics, and white patients with Hispanic patients tending to have more severe joint pain and activity limitations.

African Americans were 53% less likely to be receiving biologic DMARDs compared to Caucasians, whereas Hispanics had a 36% increased odds of receiving biologic DMARDs. The figures were reached after adjusting for age, gender, insurance coverage, twelve comorbid conditions, RA related prescription use, RA related inpatient stay, and rehabilitation visits.

Do Doctors Discriminate Against Black RA Patients?

Other hypotheses put forward to explain the difference in extent of use of biologic DMARDs in black and white patients is that black patients may remain sceptical over the benefits of these powerful drugs because they know less people taking them and experiencing joint pain relief. Doctors may also be implicated in the disparity between patients’ use of these anti-rheumatic drugs as part of conservative therapy as some may have misconceptions over the severity of disease in patients, raising the issue of possible discrimination when doctors deal with people of different ethnicities.

The onset of neck pain, back pain, or other joint pain along with fatigue, fever, and other symptoms of rheumatoid arthritis should be investigated by a qualified physician to rule out or diagnose rheumatoid arthritis early. Patients may then be better able to benefit from biologic DMARDs in the early stages of the disease, regardless of their race.


Chu, L-H., Portugal, C., et al, (2012), Racial/ethnic differences in receiving biologic dmard treatment among california medicaid rheumatoid arthritis patients, Arthritis Care Res 2012.

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