Racial, Ethnic Disparities Observed in Patients with Psoriatic Arthritis

Results of a recent survey highlighted the dissatisfaction with overall care and confirmed racial and ethnic disparities in patients with psoriatic arthritis (PsA), including delays in time to diagnosis and treatment-related aspects. The data, “Racial/Ethnic Differences in Psoriatic Arthritis Patient Responses Regarding Disease Burden, Treatment, and Communication with Care Team,” was presented at the American College of Rheumatology’s 2023 Convergence in San Diego, California.¹

To analyze the differences in disease burden, as well as various aspects of care among racial and ethnic groups, investigators created a survey assessing quality of care. The survey, which was deployed between September to October 2022, was sent out to 455 patients with PsA though an advocacy organization email list as well as a national patient survey organization. Patients self-reported their race and ethnicity. If patients chose “White” as well as another racial/ethnic group, they were included in both analysis groups.

The ages of patients ranged between 28 to 91 years, 391 participants identified as White, and 76 identified as a minority group including African America/Black (n = 29), Asian/Pacific Islander (n = 20), Hispanic/Latinx (n = 14), Native American/Alaska Native (n = 8), and “other” (n = 5).

Patients with PsA in the self-reported racial and ethnic minority were less likely to be diagnosed within 12 months of symptom onset compared with White patients (50% vs 71%, P <.001) and were more frequently uninsured (8% vs 1%, P <.001). These patients also reported more severe disease activity (41% vs 14%, P <.001), which had an extreme impact on quality of life and emotional wellbeing (25% vs 6%, P <.001).

Patients in the racial and ethnic minority cohort were less often prescribed a biologic, and more frequently prescribed oral glucocorticoids, methotrexate, or no medication when compared with White patients with PsA. Additionally, high levels of unfamiliarity with targeted agents, including biologics or small molecule inhibitors were observed in this patient population (42% vs 81%, P <.001). These patients were also less likely to report high satisfaction with treatment compared with White patients (39% vs 77%, P <.001). The difference in concerns for risks were significant in minority populations (29% vs 3%, P <.001) and financial barriers to managing their disease were 4-fold more common (26% vs 7%, P <.001).

Gaps in communication with the care team were reported within the minority cohort, as patients were less likely to believe they are very or extremely involved in shared decisions regarding care (60% vs 82%, P <.001) when compared with White patients.
Although White patients with PsA were more likely to express they wanted more time to discuss the pros and cons of different medication options (67% vs 30%) as well as other health conditions they may be at risk for (76% vs 36%), they were less likely to indicate they wanted to focus on the impact of their disease on emotional and mental health (14% vs 32%) and quality of life, such as the ability to work, socialize, and exercise (10% vs 34%). Interestingly, the advantages and disadvantages of treatment options and comorbidities was a lower priority among the minority cohort, despite experiencing a higher percentage of comorbid disease.

“There is a need for more time to be spent on educating individuals with PsA to enable shared decisions and improved understanding of therapeutic options,” wrote a team of investigators led by Marykate Nelson,, PhD, director of scientific affairs at PRIME Education.

References

1. ^{Navarro-MillánI, KerrG, Carter J, Simone L, et al. Racial/Ethnic Differences in Psoriatic Arthritis Patient Responses Regarding Disease Burden, Treatment, and Communication with Care Team. Presented at: American College of Rheumatology Convergence 2023. San Diego, CA. November 10-15, 2023.}