Navigating Racial Disparities in Psoriatic Arthritis: Insights From Patient-Reported Outcomes

Individuals with self-reported moderate to severe psoriatic arthritis (PsA) experienced a higher burden of disease, particularly among Black participants who reported more absenteeism and activity impairment but lower health care utilization compared with White participants, according to a recent study.¹

PsA is a type of chronic inflammatory arthritis that impacts 1 in 4 individuals with psoriasis. It can lead to joint pain, swelling, stiffness, and limited mobility, in addition to skin issues like redness and itching. | Image credit: fusssergei - stock.adobe.com

The study, published in Rheumatology and Therapy, explored potential differences in patient-reported outcomes and economic outcomes among individuals with PsA of varying severity and different racial and ethnic backgrounds, as these differences had not been well studied previously.

PsA, a chronic inflammatory arthritis affecting 1 in 4 individuals with psoriasis, can result in pain, swelling, stiffness, and joint limitations, alongside skin symptoms like itching and redness.² This disease has a heterogeneous course, ranging from mild to severe, and significantly impacts patients' physical function and health-related quality of life (HRQOL). Individuals with PsA often experience fatigue, pain, emotional challenges, low self-esteem, and financial insecurity, indicating high disease burden and unmet needs.

While PsA is reported to be more prevalent in non-Hispanic White individuals, the difficulty in diagnosing psoriasis in individuals with darker skin tones may lead to underdiagnosis or delayed diagnosis, exacerbated by insufficient medical training on skin presentations in diverse populations. Such delays can lead to inequitable treatment and worse clinical outcomes, including irreversible joint damage and decreased functional capacity.

The study participants were drawn from the 2018, 2019, and 2020 US National Health and Wellness Survey, focusing on individuals living in the US aged 18 years and older who self-reported receiving a physician diagnosis of PsA. Patient-reported humanistic burden was evaluated through mental health, HRQOL, labor force participation, and work productivity and activity impairment (WPAI), while economic burden was assessed via health care resource utilization (HCRU) and both direct and indirect costs.

The analysis included 1544 participants with physician-diagnosed PsA, primarily non-Hispanic White (69.49%), followed by Hispanic (14.44%) and other races (8.68%), and non-Hispanic Black (7.38%). About half of the cohort was men.

Multivariable analyses revealed that participants with moderate to severe PsA had significantly worse depressive and anxiety symptoms than those with mild PsA. They also scored lower on mental and physical health measurements.

Although labor force participation rates were similar, individuals with moderate to severe PsA reported greater impairment on WPAI measures and had more health care visits in the past 6 months. However, there were no significant differences in mental health provider visits or hospitalizations.

Additionally, direct and indirect costs were significantly higher for those with moderate to severe PsA, highlighting a greater financial burden associated with increased disease severity. These findings align with previous bivariate analyses, underscoring the negative impact of disease severity on mental health and health care utilization.

In multivariable analyses assessing outcomes by race and ethnicity, there were no significant differences in depression, anxiety, or HRQOL. Labor force participation was similar across groups. However, non-Hispanic Black participants with PsA reported significantly greater absenteeism (31.11% vs 16.69%; P = .007) and activity impairment (54.27% vs 47.96%; P = .047) compared with non-Hispanic White participants. Non-Hispanic Black participants also had fewer health care provider visits (5.93 vs 7.42; P = .039) and rheumatologist visits (0.29 vs 0.53; P = .028) than non-Hispanic White participants.

Non-Hispanic White participants with moderate to severe PsA had 2.83 times higher odds of experiencing moderate to severe depression (P = .005) compared with those with mild PsA, with predicted probabilities of 46.3% for moderate to severe PsA vs 23.4% for mild PsA.

Race/ethnicity also affected HRQOL values (P = .025), with non-Hispanic White participants scoring lower (short-form 6-dimension scores, 0.56 vs 0.63; P < .001). Non-Hispanic White participants with moderate to severe PsA had significantly more emergency department visits (0.70 vs 0.45; P = .001) compared with those with mild PsA. Overall, these findings highlight the impact of race and ethnicity on PsA severity and associated HCRU outcomes.

The study had several limitations, including reliance on self-reported data for race, ethnicity, and disease severity, which may introduce bias. Small sample sizes for non-Hispanic Black and Hispanic groups limited analysis depth, while the English-only survey may have excluded non-English speakers.

The authors concluded, “This [study] underscores the need for nuanced understanding of the intricate interplay between self-reported PsA severity and race/ ethnicity. Further research is needed to explore the potential factors influencing the relationship between self-reported PsA severity and race/ethnicity, with an overall goal of addressing unmet needs in PsA management.”

References

1. Lin I, Krupsky K, Way N, et al. Patient-reported and economic racial and ethnic disparities in patients with psoriatic arthritis: results from the national health and wellness survey. Rheumatol Ther. Published online September 29, 2024. doi:10.1007/s40744-024-00717-7

2. Psoriatic arthritis. Mayo Clinic. Accessed October 11, 2024. https://www.mayoclinic.org/diseases-conditions/psoriatic-arthritis/symptoms-causes/syc-20354076