Clinical Insights, Strategies for Delivering Equitable Psoriatic Arthritis Care

In part 2 of our interview with Rebecca Haberman, MD, rheumatologist and associate director of the Psoriatic Arthritis Center at NYU Langone Health, she discusses the clinical implications of her findings on racial and ethnic differences among patients with psoriatic arthritis (PsA). Haberman also highlights ways providers can use these insights to deliver more equitable, patient-centered care for those of all backgrounds with PsA.

To explore these topics further, watch part 1 here.

This transcript has been lightly edited for clarity; captions were auto-generated.

Transcript

Your study found that Hispanic and non-White patients had higher tender joint counts and were more likely to have radiographic axial disease. What are the potential clinical implications of these findings?

We see these differences, and I will start by saying that this study doesn't tell us why they have these differences quite yet, but it's really the first step in realizing that there are differences. So, in terms of the radiographic axial disease, we found this particularly interesting because often we think of axial disease as a HLA-B27 [human leukocyte antigen B27]–related manifestation. HLA-B27 is a genetic marker that's much more common in White individuals.

So, what this study is telling us is that we do need to be on the lookout for axial involvement in our non-White patients. We can't dismiss their back pain as just mechanical or physical; we actually have to look for whether or not it's inflammatory. This difference may be due to different disease presentations and genetics underlying it.

The difference in tender joint count is likely more due to a difference in the experience of pain. But why this is, really, we don't know, but I will point out that when we follow patients prospectively over time, this gap in the tender joint count closes. That suggests that we're probably missing the presence of some variable there—for example, access to care—that may be explaining those differences. So, really making sure that we are attending to all of our patients, their concerns, asking them clinically how they're feeling.

In addition, we actually found that non-White patients, specifically Hispanic and Asian patients, have more psoriatic skin involvement. That's also something that's seen in some of those prior skin psoriasis studies, and we saw those differences despite similar use of systemic therapies. That might imply that non-White individuals have different therapeutic responses, making them even more vital, and I know we will talk about this a little more, too, that we have more representation of these populations in our clinical trials.

How can clinicians apply your study’s findings to provide more equitable, patient-centered care?

I think the first and, honestly, the most important thing is that we even recognize psoriasis and PsA in these patients who are not White. So, to realize that a lot of patients can present in different ways and that psoriasis does not have to have that classic red, scaly presentation to be psoriasis. So, to be more on the lookout so we're able to identify it, diagnose it, and then actually start to treat it.

Then, I think it's just to be more in tune with our patients. Again, as I mentioned, making sure that that back pain isn't mechanical, that we're looking into it, making sure it's not a psoriatic manifestation of disease, making sure that their skin is clearing on the same medications, and making sure that not only are we controlling inflammation, but we're controlling pain in these patients, as well.