Black, Hispanic RA Patients Do Not Have Worse Pain and Function at Time of Arthroplasty

Previous research has found that black and Hispanic osteoarthritis patients, compared to white patients, have poorer baseline pain and function when presenting for total hip arthroplasty (THA) or total knee arthroplasty (TKA). However, the same may not be true for black and Hispanic patients with rheumatoid arthritis (RA), according to a study published in the August: Health Disparities issue of BMC Rheumatology.

“For patients with RA, therapy utilization, disease activity, and health-related quality of life are also linked to race, socioeconomic status, and educational attainment. Similarly, Black and Hispanic patients with RA who received ongoing care for their disease in community-based practices have previously been shown to have worse pain and function and higher disease activity scores compared to White patients,” the researchers explained.

RA patients undergoing THA or TKA were preoperatively evaluated between October 2013 and November 2018 using the visual analog scale (VAS), Multidimensional Health Assessment Questionnaire (MDHAQ), and Disease Activity Score (DAS28-ESR). Patients self-reported race, education, income, insurance, and medications. Analyses were performed to determine whether race was correlated with baseline pain, function, and RA disease activity.

Final analysis included 164 patients, of whom 37 (23%) were black or Hispanic. There were no significant between-group differences in MDHAQ and DAS28-ESR, but minority patients had significantly poorer VAS pain scores. Education was similar between the groups, but insurance differed largely—29% of minority patients had Medicaid, compared to 0% of white patients. Multivariable analyses observed no correlation between minority status and DAS28-ESR, MDHAQ, or VAS pain score.

The researchers concluded that “in a cohort of highly educated patients with RA receiving care at a high volume academic surgical hospital, residing in communities with low levels of poverty despite significant poverty at the individual level, we find that Black and Hispanic patients with RA do not have worse pain, function, or disease activity at the time of arthroplasty. There was no difference in biologic usage across minority status.”