Ethnic Disparities: How Race Impacts Psoriatic Arthritis

Updated on August 12, 2021

Medically reviewed by Marissa Sansone, MD

Psoriatic arthritis (PsA) is a form of chronic inflammatory arthritis often linked to the autoimmune skin condition psoriasis. Whites are more often affected by PsA, according to numerous studies. The research also shows Black Americans, Asians, and Latinxs are less frequently diagnosed with PsA.

Lower incidences might have more to do with limited access to care and lower awareness of the condition among these ethnic groups. While speculated, this theory has not been confirmed by any clinical study.

Additionally, these groups appear to have a higher disease burden and reduced quality of life resulting from barriers to health care. Disease burden includes health, economic, social, and other effects on both the individual and society.

Keep reading to learn about PsA race and ethnic prevalence, diagnostic challenges, disease burden, and more.

Ethnic Disparities in Psoriatic Arthritis Care — Verywell / Nusha Ashjaee

Overview of PsA

Psoriatic arthritis is thought to affect less than 1% of the U.S. population. Exact prevalence percentages for PsA are difficult to pinpoint. This is due to a lack of uniform diagnostic criteria. Also, symptoms vary from person to person and sometimes across ethnicities and races.

Symptoms of PsA include joint pain, stiffness, and swelling that flares up and subsides. PsA can also cause:

Chronic fatigue
Severe swelling of fingers and toes
Back and shoulder pain
Chest and rib pain
Inflammation in the areas where muscles connect to a bone
Skin inflammation (red patches of inflamed skin)
Nail symptoms, such as nail pitting and nail bed separation

PsA occurs because the body’s immune system attacks healthy tissues. It is unknown why this happens, but researchers believe genetics and environmental factors play a part.

PsA commonly affects adults between the ages of 35 and 55, but it can affect anyone of any age or gender. It can also affect people regardless of race or ethnicity.

Treatment includes medications to reduce inflammation and the body’s overactive response, oral corticosteroids and injections, and joint replacement surgery in severe cases.

Prevalence

Research on prevalence in the U.S. population shows psoriatic arthritis mainly affects White Americans.

A 2021 study looked at PsA cases from Olmsted County, Minnesota residents ages 18 and up during two periods—1970–1999 and 2000–2017. The researchers found increased incidences of PsA in the White residents, with these numbers remaining stable over the five decades and considerably more so from 2000–2017.

One 2015 study published in the journal Clinical Rheumatology found significant gaps in clinical measures for both psoriasis and PsA existed between Black and White populations. According to the study results, PsA occurred less frequently in Blacks compared to Whites—30% vs. 64%. This study also showed a greater disease burden for Blacks.

Studies of U.S. Latinx populations find psoriatic disease (PsA and psoriasis) affect Latinx Americans at a lower rate than White Americans. However, much like Black Americans, this group is more severely impacted by psoriatic disease.

South Asian people are also less frequently affected by PsA compared to Whites. In addition, PsA is more common in White families than in South Asian families. Among South Asians, people of Pakistani background are more than three times more likely to have PsA compared to other South Asian populations.

Diagnostic Challenges

People with darker skin tones are often underrepresented in rheumatology clinical image banks, according to a 2021 report in the journal Arthritis Care & Research.

These disparities are important to diagnosis and health outcomes. This is because clinical imaging helps doctors to understand various aspects of rheumatic disease, including the effects of joint disease, skin manifestations of disease, comorbidities (other health conditions the person has), and complications.

Dark skin is also underrepresented in rheumatology education, especially as it pertains to Asian Americans, Native Americans, and Black Americans.

Another obstacle is that it takes more than two years from when joint pain symptoms start for someone to be diagnosed with PsA regardless of ethnicity or skin color.

A study presented at the 2020 American College of Rheumatology’s annual meeting found more than half of the participants had at least two years between disease onset (when they first reported joint symptoms to their doctor) and getting a PsA diagnosis. People with psoriasis were more likely to get a diagnosis in less than two years.

Diagnostic delays are much more common in communities where people do not have adequate access to rheumatologists, who are much better equipped to diagnose conditions like PsA.

Some of this is related to workforce shortages and lack of access to rheumatology in general. But these accessibility issues tend to affect and limit racial and ethnic minorities the most.

Quality of healthcare obstacles seems to exist and is most difficult for people of color, regardless of the type of healthcare professional they are seeing.

According to a 2015 study in the American Journal of Public Health, dark-skinned people might receive a lower quality of care compared to White people. These researchers also found that healthcare professionals were more generally positive about White people and negative about people of color.

Higher Disease Burden

Studies suggest the quality of life with psoriatic arthritis is significantly worse for people of certain races and backgrounds. Differences also exist in disease outcomes, access to stronger therapies, and the existence of comorbidities.

Black Americans

In the previously mentioned 2015 Clinical Rheumatology study, researchers looked at adult outpatients with confirmed PsA and psoriasis at four urban academic institutions. They considered physician-reported disease outcomes, quality-of-life measures, use of systemic therapies, and any comorbid conditions.

They found the use of biologic therapies was greater in Whites compared to Blacks—46.2% vs. 13.3%, respectively. That limited accessibility to biologic drug therapies translated into more disease involvement, lowered quality-of-life measures, and greater psychological impact.

The study’s authors also noted that Black Americans with PsA will also have more severe skin involvement, which further adds to their disease burden.

Latinx Americans

In Latinx groups, most of the research looks at disease severity in psoriatic disease, especially psoriasis, and not PsA on its own. A 2020 study found disease severity and lowered quality of life in this group is notable when compared to White Americans. Also, Latinx Americans had a higher risk for comorbidities, including depression and diabetes.

The combination of barriers and lack of involvement and research limits the understanding of disease processes and outcomes. This translates into disparities in diagnosis, care, and treatment for Latinxs with PsA.

The study’s authors conclude that there is a need for future studies to look at these disparities in greater detail for Latinxs and other racial and ethnic groups in the United States.

South Asian Americans

Researchers have found South Asian Americans with PsA report higher pain levels, increased disability incidences, and more tender and swollen joints. This group is also less likely to be treated with biologic drug therapies, whereas people of European backgrounds have better access to these treatments.

The researchers noted these ethnic differences might have an impact on the long-term outcomes of people with PsA.

A second study reported in 2020 in people of South Asian and North European backgrounds compared clinical and radiological characteristics of PsA in these groups.

The people with South Asian backgrounds had more severe disease, including tender and swollen joints, more severe enthesitis (inflammation in the areas where the bone connects to tendons and ligaments), more severe skin disease, and worse disease activity scores.

The people with South Asian backgrounds also had poorer quality of life and more reduced function. The study’s authors noted that further studies are necessary to better understand the reasons for these differences.

Improving Your Outcomes

The long wait for a psoriatic arthritis diagnosis can take a toll. That effect is evident in studies related to diagnosis, care, treatment, and quality of life in different ethnic and racial groups. Much of this is linked to reduced access to health care and delayed diagnoses.

But this doesn’t have to be the case for you. It is possible to receive a timely diagnosis and effective care and treatment regardless of race or ethnicity. This involves taking charge of your health and pressing to get a correct diagnosis and access to good quality care.

Taking charge of your health care means learning all you can about PsA, tracking symptoms and what causes and improves them, finding the right doctor, and being a strong advocate for yourself.

Taking Charge of Your Psoriatic Arthritis — Verywell / Nusha Ashjaee

Learn About PsA

According to the National Psoriasis Foundation, psoriasis affects up to 33% of people with PsA, and it often occurs before PsA. Additionally, up to 40% of people who get PsA have a relative with PsA or psoriasis. If psoriatic arthritis and/or psoriasis run in your family, or if you already have psoriasis, you are at an increased risk for developing PsA.

With the misconceptions and lack of data on how PsA and psoriasis affect people of certain racial and ethnic backgrounds, many people within these groups may be undiagnosed. Because medical training for PsA favors understanding symptoms and disease activity in people with lighter skin, other groups tend to be underrepresented.

To address these obstacles, it makes sense to learn about how the condition affects other members of your family. If you already have psoriasis, you will want to ask your treating doctor what symptoms of PsA you should look for.

Educating yourself about PsA and how it affects people who share your race or ethnicity increases your chances of early diagnosis and earlier access to treatments. These advantages could mean reduced disease activity and/or remission (low or no disease activity or symptoms) down the road.

Take Notes

As soon as you start experiencing PsA symptoms, make notes and keep track of what is happening and what you are feeling. For example, if you experience joint or skin symptoms from stress, your doctor needs to know. Or, if getting an infection or minor illness triggers symptoms, make your doctor aware of this trigger.

You might also consider taking pictures of any rashes that show up on your skin and eventually resolve. Your doctor needs to see what is happening to your skin, and oftentimes your skin might clear up by the time your appointment comes around.

Find a Doctor Who Understands You

It is important to find a doctor who understands you and your unique health situation. Sometimes, it makes sense to find a doctor who understands your ethnicity or race.

That might be someone who has worked extensively with minority groups or who shares your skin color or ethnic background. Or, it could be a doctor who has treated you for many years or someone who has successfully treated a family member with psoriasis or PsA.

Also, it is OK to ask a doctor’s office if they treat people with darker skin tones or of certain ethnic backgrounds. They should be able to answer your questions openly and honestly. If they can’t or are confused by your question, you may want to find someone else to treat you who understands conditions that affect people of your ethnicity or race.

However, the race or ethnicity of a doctor isn’t always important. If you can find a dermatologist and/or a rheumatologist who listens, this alone can help reach a diagnosis and improve your treatment outcomes.

Psoriatic Arthritis Doctor Discussion Guide

Get our printable guide for your next doctor’s appointment to help you ask the right questions.

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Be Your Strongest Advocate

If you feel like your doctor or their staff members aren’t listening to your concerns, it is important to speak up. Nobody knows your body better than you do, so tell them about what is ailing you, especially if you feel like you are being dismissed.

It is also important to ask questions about diagnostic testing and treatments. If you are unsure about whether a treatment will help or about side effects, say something.

If you think you have been misdiagnosed, you are allowed to seek out a second opinion. Find a different doctor, and let that person know why you think you have been misdiagnosed. Share what you learned about your symptoms and triggers to help a new doctor determine appropriate testing to reach a correct diagnosis.

Summary

Studies have shown disparities in the diagnosis, treatment, and quality of life for Americans who are not White. This can stem from there being fewer clinical images of people with darker skin tones (making diagnosis more difficult) and less access to rheumatologists. People can address these disparities by knowing their family history of psoriatic disease, recognizing and reporting any symptoms early, and finding a doctor who can best treat people of their ethnicity.

A Word From Verywell

Regardless of your ethnicity or race, it is important to work with your doctor to find ways to improve your quality of life and the effects of PsA on your body. Make sure you are getting the support necessary to keep your health care and treatments on track, as well as to keep PsA from affecting your emotional health.

Support can come from family and friends and others living with the condition. You can connect with others living with PsA through social media or online and in-person support groups.

14 Sources

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