4 years ago

Early Rheumatoid Arthritis Presentation, Treatment and Outcomes in Aboriginal Patients in Canada: A Canadian Early Arthritis Cohort Study Analysis

Orit Schieir, J Carter Thorne, Janet Pope, Susan J. Bartlett, Edward Keystone, Gilles Boire, Sujay Nagaraj, Boulos Haraoui, Diane Tin, Cheryl Barnabe, , Carol Hitchon, Vivian P. Bykerk
Objective Health inequities exist in chronic diseases for Aboriginal people. This study compared early rheumatoid arthritis (ERA) presentation, treatment and outcomes between Aboriginal and Caucasian patients in a large Canadian cohort study. Methods Longitudinal data from the Canadian early ArThritis CoHort (CATCH), a prospective multicenter ERA study, were analyzed for participants who self-identified as Aboriginal or Caucasian ethnicity. Disease characteristics at presentation, prognostic factors, frequency of remission and disease-modifying therapy strategies were contrasted between population groups. Linear mixed-models were used to estimate rates of change for disease activity measures up to five years. Results At baseline, 2173 participants (Aboriginal n=100, Caucasian n=2073) had similar mean (SD) symptom duration (179 (91) days), DAS28 (4.87 (1.48)) and HAQ (0.88 (0.68)) scores. Factors associated with poor prognosis were more frequently present in Aboriginal participants, but disease-modifying therapy selection and frequency of therapy escalation was similar between groups. DAS28 remission was achieved less frequently in Aboriginal than Caucasian participants (adjusted OR 0.39, 95%CI 0.25 to 0.62). Results were primarily driven by slower improvement in swollen joint counts and non-significant improvement in patient global scores in Aboriginal participants. Pain levels remained higher in Aboriginal patients. Conclusions Aboriginal ERA patients experienced worse disease outcomes. This may reflect unmeasured biological differences and/or disparities in prognostic factors informed by inequities in determinants of health. The appropriateness of current treatment strategies applied in different contexts should be considered. This article is protected by copyright. All rights reserved

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1002/acr.23470

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