Do Black Children Have Poorer Polyarticular JIA Outcomes When Initiating Treat-to-target Interventions?

Despite improvements over time, Black children with polyarticular juvenile idiopathic arthritis (JIA) had poorer outcomes than White children throughout a treat-to-target (TTT) intervention incorporating clinical decision support (CDS).

Previous data have indicate racial disparities in Black children with polyarticular JIA: “In a cross-sectional study using the Childhood Arthritis and Rheumatology Research Alliance registry, African American children with polyarticular JIA had a nearly two-fold higher odds of joint damage compared to their white counterparts,” the study authors noted.

The researchers retrospectively evaluated a TTT-CDS intervention implemented at a single institution from 2016 to 2019, with the main outcome being the Juvenile Arthritis Disease Activity Score (cJADAS-10).

A total of 159 children with polyarticular JIA were identified; the median age at the time of the index visit was 12 years (interquartile range [IQR], 7.2-14.7 years). The median number of visits per patient after the intervention was implemented was six (IQR, 4-8), for a total of 998 visits, and median follow-up time was 30 months (IQR, 20-36). Three-quarters of the cohort was White (n=117 [74%]), while 21 patients each were Black and Asian/other. Black patients, compared to their White counterparts, were more likely to be male, rheumatoid factor (RF) positive, and publicly insured.

Racial disparities were observed at the index visit. Black children had a significantly higher median cJADAS-10 (13.6 [IQR, 9.5-19]) than White children (2.4 [IQR, 0.1-6.8], P<0.01) and Asian/other race (5.6 [IQR, 0.5-13.8], P<0.01). When adjusting for age, disease duration, and DMARD use, Black patients, compared to White patients, had a 3-point higher cJADAS-10 at the index visit (95% confidence interval [CI], 0.5-5.5; P=0.02). When looking at three specific cJADAS-10 components, Black patients had significantly higher physician global and patient global scores than White patients, but estimated joint count did not largely differ between the groups. Also at the index visit, Black patients had significantly higher adjusted pain scores and lower mobility, but upper extremity physical function did not largely differ.

Significant improvements in cJADAS-10 were observed over time across all races in incident and prevalent disease cases. The adjusted cJADAS-10 score over time for Black children with incident cases (n=12) was, on average, 2.5 points higher than that of their White counterparts, and for Black children with prevalent cases (n=9), 1.2 points higher.

Regarding CDS use, it did not appear to be associated with disease activity in prevalent or incident cases, but in prevalent cases, race and CDS use were significantly correlated: Black children with ≥50% CDS use exhibited an average 3.9-point lower cJADAS-10 score overtime when compared to Black children with <50% CDS use.

The study was published in Pediatric Rheumatology.