Indigenous patients with rheumatoid arthritis (RA) in Canada have higher disease activity, a lower rate of remission, and an increased risk for all-cause hospitalization compared with nonindigenous patients with RA, according to results published in The Journal of Rheumatology.

The study included participants initiating biologic therapy in Alberta from 2004 to 2012 (n=1490). The researchers characterized participants by disease severity and treatment response.

The results showed that indigenous participants (n=90) presented with higher disease activity (mean 28-joint count Disease Activity Score [DAS28], 6.11) compared with nonindigenous participants (n=1400, mean DAS28 score, 5.19; P <.0001).


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There were no differences in improvements in disease activity, function, swollen joint count, C-reactive protein, and patient and physician global evaluation scores between the groups. However, indigenous participants did not have a significant improvement in erythrocyte sedimentation rate (−0.31 per month; 95% CI, −0.79 to 0.16; P =.199).

At the end of follow-up, 13% (n=12) of indigenous participants achieved DAS28 remission compared with 33% (n=455) of nonindigenous participants.

Compared with nonindigenous participants, indigenous participants had a 40% increased risk for all-cause hospitalization (adjusted incidence rate ratio, 1.4; 95% CI, 1.1-1.8; P =.01) and a 4-fold increase in serious infection rate (adjusted incidence rate ratio, 4.0; 95% CI, 2.3-7.0; P <.001).

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Nonindigenous participants had higher costs for RA-related hospitalizations (difference, $896; 95% CI, $520–$1273; P <.001) and outpatient department visits (difference, $128; 95% CI, $2–$255; P =.047) compared with indigenous participants.

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Reference

Barnabe C, Zheng Y, Ohinmaa A, et al. Effectiveness, complications, and costs of rheumatoid arthritis treatment with biologics in Alberta: experience of indigenous and non-indigenous patients [published online June 1, 2018]. J Rheumatol. doi: 10.3899/jrheum.170779