Challenging Perceptions: Exploring Racial, Ethnic Disparities in Psoriatic Arthritis

In part 1 of an interview with The American Journal of Managed Care®, Rebecca Haberman, MD, rheumatologist and associate director of the Psoriatic Arthritis Center at NYU Langone Health, discusses how the historical perception of psoriatic arthritis (PsA) as a "Caucasian" disease has shaped clinical understanding and research efforts. She also shares what inspired her to explore racial and ethnic differences among patients with PsA in a recent study.

This transcript has been lightly edited for clarity.

Transcript

Given that PsA was historically considered a "Caucasian" disease, how has that perception influenced clinical understanding and research efforts?

A lot of times, people are thinking of psoriasis and PsA as White diseases. So, a lot of times, people who are non-White get kind of ignored or put almost on the back burner. First of all, clinically, psoriasis doesn't look the same on all skin tones. So, a lot of times psoriasis in itself can be undiagnosed or even misdiagnosed. Then, once they don't have psoriasis, the first thing that comes to mind for rheumatologists is not necessarily PsA.

When you look at studies, especially clinical trials, they're often over 90%, sometimes over 95%, White. This doesn't reflect accurately the prevalence of the disease, as is seen in nationwide studies or surveys. Dr April Armstrong had done a study looking at the NHANES [National Health and Nutrition Examination Survey] survey data and found that the prevalence of psoriasis, so skin psoriasis, is 3.6% in White individuals but also 2.5% in Asian individuals, 1.9% in Hispanic individuals, and 1.5% in Black individuals.

The same sort of breakdown in pattern is seen in PsA. So, even though, yes, the prevalence might be higher, it's certainly not everyone who has this disease. So, we've really been almost neglecting a little bit the other parts of this disease.

What motivated you to investigate racial and ethnic differences in PsA? What gaps in the literature were you hoping to address?

So, there isn't that much research out there actually looking at this. A lot of the studies that are out there focus on skin psoriasis, in particular. But looking at PsA, there are maybe 2, maybe 3 studies that were already out there. What we found is we're here in New York, we have a very large urban center that includes a private network and a public hospital. Just being in New York, there's a lot of different diversity here.

What we realized is that the patients that we were seeing in our private practices at Bellevue Hospital looked different than a lot of these studies that we were seeing in the literature, that we had a very unique population that was ethnically diverse, racially diverse, socioeconomically diverse, just a ton of diversity there. So, we found ourselves in a really unique position to look at this. So, we decided that we really wanted to focus on how our population can contribute largely to the PsA research throughout the country and throughout the world.