African-Americans with rheumatoid arthritis are less likely than whites to be on the sort of powerful meds that prevent further joint damage and disability, according to a new study. And despite the severity of the arthritis, the study found African-Americans were half as likely to be on what are called biologic disease-modifying anti-rheumatic drugs, or DMARDs, compared to less-potent standard arthritis drugs,Reuters reports.
The study analyzed 5,385 Medi-Cal rheumatoid arthritis patients who were in their 50s and 60s, on average, and were treated with at least one rheumatoid arthritis drug in California between 1998 and 2005. Overall, 16 percent of white patients took biologic DMARDs, which included Enbrel and Humira. The others took standard DMARDs, such as methotrexate, which is sold as Rheumatrex, and Arava. But only 9 percent of African-Americans took the more potent drugs. Hispanics with rheumatoid arthritis were most likely to be on biologic DMARDs - 20 percent took those meds.
Why were African-Americans less likely to be treated with DMARDs, even if their disease was as severe as white patients? "If patients do not have access to physician specialists who are better at management of (rheumatoid arthritis), this can affect the choice of DMARDs they are receiving," Aniket Kawatkar, who is one of the study authors and works at Department of Research and Evaluation at the Southern California Permanente Medical Group, told Reuters. "Secondly, ethnic and cultural beliefs may hinder certain minorities from seeking care immediately."
The researchers noted that standard DMARDs, which are usually taken orally, typically cost a few hundred dollars a year, while biologics can cost between $15,000 and $25,000, although these meds are often covered by Medicaid with prior approval. The study was published in Arthritis Care & Research (here is the abstract).
One immunologist from the University of Alabama at Birmingham, who was not involved in the study, called the findings "unsettling." African-Americans with rheumatoid arthritis may know fewer members of their community who are on biologic DMARDs, and so aren't as comfortable trying them, Ken Saag speculates in an interview with Reuters. Conversely, he posits that some docs may have misconceptions about arthritis not being as severe in certain types of patients.
"Regrettably, there may be elements of discrimination in terms of what therapies are offered to people," Saag tells Reuters. He noted that in some practices, as many as 60 percent of rheumatoid arthritis patients are taking the more potent - and expensive - drugs.