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Are Race and Ethnicity Risk Factors in Rheumatoid Arthritis?

Posted on March 16, 2022
Medically reviewed by
Ariel D. Teitel, M.D., M.B.A.
Article written by
Eli Sachse, RN

The risk for developing rheumatoid arthritis (RA) is associated with many factors, including genetics and environmental conditions. People of some races and ethnicities are more likely than others to develop RA or to experience more severe RA. Since race and ethnicity can influence health in many ways, details of the connection between race and ethnicity and risk for RA are not fully clear.

Genetics vs. Race

Traditionally, some researchers have assumed that diseases that appear linked to race and ethnicity also share a genetic link. However, research increasingly indicates that there is no genetic basis for race.

That said, research does show a correlation between some genes that suggest increased risk for RA in certain Native American groups. Studies also show genes that appear to protect against RA are more prevalent among people of Northern European and Japanese descent. This may explain some of the risk differences among these racial groups.

Race, Ethnicity, and Risk for Developing RA

Studies show that some people of some races and ethnicities are more likely to develop RA.

You should know: the top 3 risk factors for developing RA

Globally, certain Native American tribes (Pima and Chippewa) seem to have the highest risk of developing RA.

According to the Journal of Clinical Medicine, non-Hispanic African Americans have a higher risk of developing RA compared with non-Hispanic Caucasians. Other research has found low occurrences of RA in people from Southeast Asia, including China and Japan.

Studies show that, between 2005 and 2018, RA diagnoses increased among Hispanic people in the United States. It’s unclear what is behind this uptick in diagnosis among this population.

Race, Ethnicity, and RA Symptom Severity

The severity of RA symptoms also varies across different racial and ethnic groups. In the U.S., Hispanic people appear to experience increased disease severity when compared to non-Hispanic white people, according to a study from the American Journal of Medicine. Non-Hispanic African Americans also appear at risk for more severe RA symptoms when compared to non-Hispanic white Americans, per the Journal of Clinical Medicine.

There are different ways to measure severity in cases of RA, including disability, pain, function, and achievement of remission — a state when people with RA feel better and symptoms improve.

Studies have shown:

Overall, researchers have found that white and Asian people appear better able to achieve remission, less pain, and better daily functionality when compared to Black and Hispanic people. The reasons for these differences may result from a complex combination of factors.

Researchers have found that stress is linked to autoimmune and rheumatic diseases. Some theorize that African Americans and Hispanic Americans, who are more at risk for disadvantaged socioeconomic status, are more at risk for severe RA due to the stress of experiencing poverty and disability.

Differences in Treatment

Early referral to a rheumatologist and early treatment with disease-modifying antirheumatic drugs (DMARDs) is shown to improve the long-term outcomes in people with RA. For this reason, delays in diagnosis or treatment can affect how severe RA becomes and how it progresses over time.

Studies show that:

Choice of DMARD may also differ along racial lines. One study examined preferences in DMARDs among Americans with RA. For the study, participants were asked to identify themselves as Black or white. The results showed that 51 percent of white people preferred a more aggressive, but more toxic, DMARD over a less aggressive but less toxic alternative. By contrast, 16 percent of the Black participants opted for the more aggressive treatment.

Diversifying Research and Rheumatology

More research is needed in order to understand why some people of particular racial and ethnic groups are more at risk for developing RA and experiencing more severe symptoms. The question is further complicated by the fact that people of color are underrepresented in clinical trials for RA and genetic research as a whole. Efforts are underway to better understand the reasons behind the lack of diversity in clinical research and how to ensure that trial participation will be more diverse and inclusive in the future.

Rheumatology is one of the least diverse fields of medicine, with only an estimated 25 percent of people of color among providers in the United States. However, the American College of Rheumatology has announced plans to actively recruit trainee doctors with more diverse backgrounds into rheumatology programs going forward.

Talk With Others Who Understand

On myRAteam, the social network for people with rheumatoid arthritis and their loved ones, more than 181,000 members come together to ask questions, give advice, and share their stories with others who understand life with rheumatoid arthritis.

Do you still have questions about RA in different races and ethnicities? Share in the comments below, or start a conversation by posting on your Activities page.

References
  1. Rheumatoid Arthritis (RA) — Centers for Disease Control and Prevention
  2. Social Determinants of Health — U.S. Department of Health and Human Services
  3. Race and Genetics Versus ‘Race’ in Genetics: A Systematic Review of the Use of African Ancestry in Genetic Studies — Evolution, Medicine, & Public Health
  4. Rheumatic Diseases in North America’s Indigenous Peoples — Seminars in Arthritis and Rheumatism
  5. The Genetics of Rheumatoid Arthritis — Rheumatology (Oxford)
  6. Epidemiology and Genetics of Rheumatoid Arthritis — Arthritis Research
  7. Prevalence Trend and Disparities in Rheumatoid Arthritis Among US Adults, 2005–2018 — Journal of Clinical Medicine
  8. Racial and Ethnic Disparities in Disease Activity in Rheumatoid Arthritis Patients — The American Journal of Medicine
  9. Early Referral Recommendation for Newly Diagnosed Rheumatoid Arthritis: Evidence Based Development of a Clinical Guide — Annals of the Rheumatic Diseases
  10. Racial Disparities in Treatment Preferences for Rheumatoid Arthritis — Medical Care
  11. Treatment Disparities Among the Black Population and Their Influence on the Equitable Management of Chronic Pain — Health Equity
  12. Patient Preferences and Satisfaction in the Treatment of Rheumatoid Arthritis With Biologic Therapy — Patient Preference and Adherence
  13. Demographic Characteristics of Participants in Rheumatoid Arthritis Randomized Clinical Trials: A Systematic Review — Rheumatology
  14. Inclusion of Racial and Ethnic Minorities in Genetic Research: Advance the Spirit by Changing the Rules? — The Journal of Law, Medicine & Ethics
  15. Factors Associated With Participation in Rheumatic Disease–Related Research Among Underrepresented Populations: A Qualitative Systematic Review — Arthritis Care & Research
  16. New ACR Subcommittee Will Advance Diversity, Equity & Inclusion — The Rheumatologist
  17. Ethnic-Specific Genetic Analyses in Rheumatoid Arthritis: Incremental Gains but Valuable Contributions to the Big Picture — Arthritis and Rheumatism
  18. The Effects of Race/Ethnicity and Physician Recommendation for Physical Activity on Physical Activity Levels and Arthritis Symptoms Among Adults With Arthritis — BMC Public Health

All updates must be accompanied by text or a picture.
Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
Eli Sachse, RN is a registered nurse living in California. He has written about health topics for Sonoma Medicine and Microcosm Publishing. Learn more about him here.

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