Disparities in rheumatoid arthritis outcomes for North American Indigenous populations

Abstract

Advances in rheumatoid arthritis (RA) management have significantly improved clinical outcomes of this disease; however, some Indigenous North Americans (INA) with RA have not achieved the high rates of treatment success observed in other populations. We review factors contributing to poor long-term outcomes for INA with RA. We conducted a narrative review of studies evaluating RA in INA supplemented with regional administrative health and clinical cohort data on clinical outcomes and health care utilisation. We discuss factors related to conducting research in INA populations including studies of RA prevention. NA with RA have a high burden of genetic and environmental predisposing risk factors that may impact disease phenotype, delayed or limited access to rheumatology care and advanced therapy. These factors may contribute to the observed increased rates of persistent synovitis, premature end-stage joint damage and mortality. Novel models of care delivery that are culturally sensitive and address challenges associated with providing speciality care to patients residing in remote communities with limited accessibility are needed. Progress in establishing respectful research partnerships with INA communities has created a foundation for ongoing initiatives to address care gaps including those aimed at RA prevention. This review highlights some of the challenges of diagnosing, treating, and ultimately perhaps preventing, RA in INA populations.

Nutritional Barriers to the Adherence to the Mediterranean Diet in Non-Mediterranean Populations

“…Studies examining the impact of the Mediterranean diet on the health of Native American Indians and Alaska Natives are not available. The prevalence of rheumatoid arthritis (RA) and type 2 diabetes is high among several Native American and Alaskan Native populations [ 134 , 150 , 151 ]. Early-age onset, more severe symptoms and the pathogenesis of RA and its association with an increased frequency of the HLA DRB1*1402 allele suggests a genetic association for the high prevalence observed among American Indians and Alaskan Natives [ 150 , 151 ], particularly in women among the Yakima under the age of 35 years.…”

“…The prevalence of rheumatoid arthritis (RA) and type 2 diabetes is high among several Native American and Alaskan Native populations [ 134 , 150 , 151 ]. Early-age onset, more severe symptoms and the pathogenesis of RA and its association with an increased frequency of the HLA DRB1*1402 allele suggests a genetic association for the high prevalence observed among American Indians and Alaskan Natives [ 150 , 151 ], particularly in women among the Yakima under the age of 35 years. However, environmental factors such as diet, tobacco, coffee, infections and sex hormones may also be contributing factors to the development of RA [ 150 ].…”

“…These observations call for more studies to be performed in partnership with communities within the Native American and Alaska Native populations to understand what traditional food items can provide similar nutritional benefits to those obtained from the Mediterranean diet that are required for reducing the risk of type 2 diabetes, RA, hypertension, renal failure and cerebrovascular disease, all of which are prevalent among Native American Indian and Alaska Native populations [ 134 ]. Furthermore, such research will determine how nutrition education can be tailored for each community to facilitate long-term adherence to healthy food preparation and consumption [ 151 ].…”

Nutritional Barriers to the Adherence of the Mediterranean Diet in Non-mediterranean Populations

“…Studies examining the impact of the Mediterranean diet on the of Native American Indians and Alaska Natives are not available. The prevalence of rheumatoid arthritis (RA) and type 2 diabetes is high among several Native American and Alaskan Native populations [149][150][151]. Early age onset, more severe symptoms and pathogenesis of RA and association with increased frequency of the HLA DRB1*1402 allele suggests a genetic association for the high prevalence observed among American Indians and Alaskan Natives [149,150], particularly in women among the Yakima under age 35 years.…”

“…The prevalence of rheumatoid arthritis (RA) and type 2 diabetes is high among several Native American and Alaskan Native populations [149][150][151]. Early age onset, more severe symptoms and pathogenesis of RA and association with increased frequency of the HLA DRB1*1402 allele suggests a genetic association for the high prevalence observed among American Indians and Alaskan Natives [149,150], particularly in women among the Yakima under age 35 years. However, environmental factors such as diet, tobacco, coffee, infections and sex hormones may also be contributing factors to the development of RA [149].…”