Specialist Access Eliminates Racial Gaps in Rheumatoid Arthritis DMARD Use
Racial inequities in access to modern rheumatoid arthritis (RA) therapies persist across the United States, but disappear among patients who reach rheumatology care, according to study results published in The Journal of Rheumatology.
RA is a chronic inflammatory disease that causes progressive joint destruction, disability, and premature mortality, imposing substantial clinical and economic burdens. Although conventional synthetic, biologic, and targeted synthetic disease-modifying antirheumatic drugs (DMARDs) can control symptoms and prevent irreversible damage, nearly 40% of patients fail or cannot tolerate first-line therapies, necessitating more expensive options. Yet evidence has long suggested that non-Hispanic Black and Hispanic patients experience higher disease activity and lower remission rates than non-Hispanic White patients, raising concern that unequal access to DMARDs may be driving these disparities.
“We used the Medical Expenditure Panel Survey (MEPS) to study DMARD use across adults with RA in the United States, both insured and uninsured,” explained Ashkan Ara, MD, MPH, Division of Rheumatology, David Geffen School of Medicine at the University of California, Los Angeles (UCLA), Department of Health Policy and Management, Fielding School of Public Health at UCLA, in Los Angeles, CA, and coauthors.
In the cross-sectional study, the researchers included 6260 individuals representing a weighted national population of more than 4.8 million. The use of any DMARD, conventional synthetic DMARDs, and biologic DMARDs was assessed using multivariable logistic regression models adjusted sequentially for demographic and clinical factors, socioeconomic status, and rheumatology visits.
Black and Hispanic patients were more likely to rely on Medicaid, had lower incomes and educational attainment, and were less likely to have seen a rheumatologist than White patients. White adults demonstrated the highest DMARD utilization across all categories, while the largest gaps emerged for biologic therapies. After full adjustment, Asian patients had 66% lower odds of receiving any DMARD, and Black patients had 30% lower odds compared with White patients. These differences were driven by reduced conventional synthetic DMARD use among Asian adults and lower biologic use among Black adults.
In analyses restricted to patients who had seen a rheumatologist, racial and ethnic disparities in DMARD use were no longer statistically significant.
Because MEPS includes uninsured individuals and captures prescriptions regardless of coverage, overall DMARD utilization was lower than in specialty clinic cohorts, highlighting how real-world barriers continue to limit care.
“In our present study, we observed significant racial disparities in DMARD use, with Asian patients having the lowest odds of csDMARD use and Black patients the lowest odds of bDMARD use,” concluded the study authors. “Access to rheumatologists was linked to more equitable DMARD use, suggesting a potential mechanism to advance pharmacoequity in RA,” they added.
Reference
Ara AF, Chenoweth M, Kadiyala S, Essien UR, Scannell C. Racial and ethnic disparities in disease-modifying antirheumatic drug use among adults with rheumatoid arthritis in the United States. J Rheumatol. 2025;52(12):1316-1318. doi:10.3899/jrheum.2025-0290
