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Disparities in Psoriatic Arthritis Diagnosis and Treatment

Medically Reviewed by Carol DerSarkissian, MD on July 22, 2022

There are better treatments for psoriatic arthritis (PsA) today than ever, but not everyone has the same access to them or gets equal care. That’s because of disparities, or preventable differences, based on race and socioeconomic factors like education, income, and support.

These impact your diagnosis and quality of care. They also play a role in how psoriatic arthritis affects your mental health.

Who Gets Psoriatic Arthritis?

This type of arthritis happens in 18% to 42% of people who have the skin disease psoriasis. It usually starts between the ages of 30 and 50. But it can also happen to kids with psoriasis.

Different genders may have the same risk, but at least one study found that women had psoriatic arthritis more often than men. It’s diagnosed more in white people than people of other races or ethnicities. But people of all races and skin types can get psoriasis and PsA.

What Are Disparities in Treatment?

Research shows Black people are less likely to get a correct diagnosis for their psoriatic arthritis. And when they are diagnosed, they’re less likely to get newer biologic medicines. They’re also less likely to get other medicines that can prevent joint damage.

One study found almost 50% of white people were taking biologics for psoriasis and PsA, compared to 13% of Black people. Another found Black people were 70% less likely to get biologics.

Some reasons for disparities in psoriatic arthritis treatment are:

  • Socioeconomic factors like education, income, employment, and social support
  • Health insurance
  • High treatment costs that aren’t covered by insurance
  • Differences among groups in treatment by doctors who know a lot about psoriasis and psoriatic arthritis
  • Differences among groups in treatment preferences

Racial disparities within these factors, like your socioeconomics and health insurance status, likely drive racial disparities in diagnosis and treatment.

If you live in a low-income area, for example, you’re less likely to get the best psoriatic arthritis care and treatments.

What Are Racial Disparities in Diagnosis?

One reason white people are diagnosed with it more may be, in part, because psoriasis is easier to see on light skin. Doctors may be more likely to miss or misdiagnose psoriasis in people with darker skin.

Black people who have psoriatic arthritis may be likely to be misdiagnosed as having another type of arthritis.

Racial disparities in those with psoriasis and PsA. Most research on PsA has looked at white people. More studies are needed to understand the prevalence of PsA in other races and ethnicities.

But one study found that PsA was less common in Black people with psoriasis than in white people with psoriasis. There’s also some evidence that Hispanic/Latino people might have a higher risk for severe PsA than other groups.

It’s not clear why people of different races with psoriasis would have different psoriatic arthritis rates. It could be related to their genetic differences or other factors.

It’s also possible that apparent differences, including lower rates in Black people, reflect some groups’ more limited access to care. Also, doctors who aren’t arthritis specialists may not know a lot about psoriatic arthritis. So it’s hard to tell whether the data reflects true differences among groups.

How Are Insurance and Disparities Linked?

It’s known that many people with psoriatic arthritis don’t get the best care. But the reasons why hadn’t been clear. Then a 2021 study used U.S. insurance claims data to look at those differences. It found the biggest disparities were related to health insurance.

Psoriatic arthritis was most common in older people who had Medicare. Lower income people with Medicaid insurance were less likely to be diagnosed with psoriatic arthritis. And they were less likely to receive the best care. Also, only 12% of those with Medicaid saw a doctor who specializes in treating arthritis, compared to more than 50% of those with other types of insurance.

The study also showed that white people with Medicaid got appropriate treatment more often than Black people with Medicaid.

Discrimination based on the type of health insurance you have (and whether or not you have health insurance) can affect your chances of getting timely diagnosis and care for your psoriatic arthritis.

Those with private insurance or Medicare were more likely to get a correct diagnosis, see a specialist, and have targeted treatments. The study didn’t include people without health insurance.

How’s Your Mental Health Affected?

Psoriasis and psoriatic arthritis together affect more than your skin and joints. They affect your mental health, too. Studies suggest that Black people with these conditions are more likely to feel:

  • Self-conscious
  • Embarrassed
  • Angry
  • Frustrated
  • Helpless

Research shows Black people with PsA report a lower quality of life than white people who have it. Even so, whites are more likely to get new biologic therapies to treat their PsA.

What Can You Do?

If you have, or think you may have, PsA, try to find a doctor – ideally a specialist – you can talk to and trust.

If you’re a person of color, try to find a doctor who understands your concerns and will listen to you. If you have pain, it’s important that you let your doctor know.

They should explain your treatment options. It’ll help if you’re informed about your options, including biologics.

Make sure you’re relying on reputable sources to find information. In addition to other factors, lack of information or inaccurate information can lead to disparities in your PsA diagnosis and treatment.

If you’re worried about paying for your treatment or care, ask if there are assistance programs or foundations that can help.

Show Sources

SOURCES:

Rheumatology Nurse Practice: “Health Disparities in the Management of Psoriatic Arthritis.”

Rheumatology and Therapy: “Racial Differences in Prevalence and Treatment for Psoriatic Arthritis and Ankylosing Spondylitis by Insurance Coverage in the USA.”

Arthritis Foundation: “How to Achieve Remission in Psoriatic Arthritis.”

American College of Rheumatology: “Psoriatic arthritis.”

Clinical Rheumatology: “Psoriasis and psoriatic arthritis in African-American patients--the need to measure disease burden.”

Mayo Clinic: “Psoriatic arthritis.”

RMD Open: “Disparities in healthcare in psoriatic arthritis: an analysis of 439 patients from 13 countries.”

National Psoriasis Foundation: “Psoriasis and Skin of Color.”

The Brookings Institution: “There are clear, race-based inequalities in health insurance and health outcomes.”

CDC: “Health Disparities.”

Arthritis Foundation: “How Common is Psoriatic Arthritis in People with Psoriasis?”

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