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The American Medical Association recently released a statement defining health equity as "optimal health for all," and affirming the organization's commitment to promote better health care access, diversity in the healthcare workforce, understanding of the social determinants of health, and equitable distribution of resources and high quality care. 1 Unfortunately, according to a World Health Organization report in 2015, approximately 400 million individuals globally lack access to at least one of seven essential health services as a result of workforce shortages and uneven distributions of healthcare workers. 2 In a statement published in 2001, the Institute of Medicine declared that "All health care organizations, professional groups, and private and public purchasers should adopt as their explicit purpose to continually reduce the burden of illness, injury, and disability, and to improve the health and functioning of the people of the United States." 3 Rural AmericaOne in five individuals living in the United States resides in a rural area. 4 Figure 1 depicts the distribution across the United States of urban clusters, defined by a population of 2,500 to less than 50,000 people, and urbanized clusters, defined by a population in excess of 50,000 people. 5 In 2010, of approximately 4000 rheumatologists practicing in the US, 90% were in metropolitan regions (labor market areas centered on an urbanized cluster), 3% in micropolitan (labor market areas centered on an urban cluster), and 7% in rural parts of the US. 5,6 In urban clusters, many patients travel in excess of 100 miles to see a rheumatologist. 6 Interestingly, despite the declining rural population and pullulating urban

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A 45-year-old man with HLA-B27-positive ankylosing spondylitis and ulcerative colitis had been on infliximab-dyyb (Inflectra) for 3 years. He presented to the emergency department with 3 days of bilateral auricle pain, redness, and warmth. He had intermittent fever, night sweats, sore throat, and photophobia. On examination, his ears were red, warm, and tender (Fig. , A and B). He was admitted to the hospital and treated with broad-spectrum antibiotics for possible cellulitis. His symptoms did not improve despite antibiotic treatment, and infection was ruled out. He was diagnosed with polychondritis based on clinical manifestation and started on prednisone with methotrexate. Four weeks later, his ear pain and redness had completely resolved. At that time, he was switched from infliximab-dyyb to ustekinumab given the adverse reaction and for better control of his ulcerative colitis. Our patient has previously failed treatments with all the other anti-TNF medications due to lack of efficacy. IL-17α inhibitors were not considered for our patient due to underlying ulcerative colitis.