Background/Purpose: Disparities in medication use and clinical outcomes have been reported in patients with rheumatoid arthritis (RA) and other chronic diseases.  However, there is little information regarding whether disparities exist in RA clinical outcomes in black and Hispanic patients treated in community-based rheumatology practices in the U.S..

Methods:  We examined data from RA patients (pts) participating in the Consortium of Rheumatology Researchers of North America (CORRONA) registry, an independent registry collecting patient and physician-derived data from both academic-affiliated and community-based practice sites.  Among the 30,869 RA pts enrolled in the registry across 146 academic and community-based sites, we examined data from 26,640 RA pts under the care of 109 community-based rheumatology practices.  We performed a cross-sectional study using data collected from the most recent registry visit as of 05/05/2012. We compared medication use and RA outcomes across race/ethnic groups, comparing non-Hispanic white RA pts versus black and Hispanic RA pts based on self-reported race/ethnicity categories.  Specifically, we compared measures of RA disease activity (DAS28 and CDAI), as well as patient-reported outcomes (pain VAS and HAQ score). Pairwise statistical comparisons were performed versus the white RA cohort. 

Results: The study cohorts included 23,396 non-Hispanic whites,1,890 black and 1,354 Hispanic pts. The mean duration of RA was greater for whites (11.6 yrs) vs blacks (9.4 yrs, p<0.001) and Hispanics (10.8 yrs, p<0.001).   Similar proportions of Hispanics (58.3%) and white pts (59.7%) were treated with methotrexate (MTX), and more blacks (62.4%)   were treated with MTX versus whites.  Prescribed MTX dosages were comparable across groups, although blacks and Hispanics reported taking significantly lower dosages.  Estimated MTX adherence calculated as patient-reported dosage divided by the prescribed dosage varied from 89% in whites to 78.5% in blacks and 82.6% in Hispanics. Slightly higher rates of biologic use were observed for whites (44.9%) vs. blacks (42.8), although not significantly different (p=0.07).  In comparison to whites, Hispanics actually had higher rates of biologic use (48.7%, p<0.01).  Higher levels of disease activity using both the CDAI and DAS28 were observed for blacks and Hispanics vs. whites (p<0.001, see Table). Higher patient pain scores (p<0.001) and worse functional status (p<0.001) were also reported by both black and Hispanic RA pts vs. whites.

Conclusion:   Although some differences in RA medication prescribing were observed, both black and Hispanic pts treated in community-based practices demonstrated higher RA disease activity, higher pain scores and worse functional outcomes than white RA pts.