Racial and ethnic differences in the pharmacologic management of osteoarthritis: rapid systematic review

Abstract

Background: Racial and ethnic disparities in osteoarthritis (OA) patients’ disease experience may be related to marked differences in the utilization and prescription of pharmacologic treatments. Objectives: The main objective of this rapid systematic review was to evaluate studies that examined race/ethnic differences in the use of pharmacologic treatments for OA. Data sources and methods: A literature search (PubMed and Embase) was ran on 25 February 2022. Studies that evaluated race/ethnic differences in the use of OA pharmacologic treatments were included. Two reviewers independently screened titles and abstracts and abstracted data from full-text articles. Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Results: The search yielded 3880 titles, and 17 studies were included in this review. African Americans and Hispanics were more likely than non-Hispanic Whites to use prescription non-selective non-steroidal anti-inflammatory drugs (NSAIDs) for OA. However, compared to non-Hispanic Whites with OA, African Americans and Hispanics with OA were less likely to receive a prescription for cyclooxygenase-2-selective NSAIDs and less likely to report the use of joint health supplements (i.e. glucosamine and chondroitin sulfate). There were minimal/no significant race/ethnic differences in the patient-reported use of the following OA therapies: acetaminophen, opioids, and other complementary/alternative medicines (vitamins, minerals, and herbs). There were also no significant race differences in the receipt of intra-articular therapies (i.e. glucocorticoid or hyaluronic acid). However, there is limited evidence to suggest that African Americans may be less likely than Whites to receive opioids and intra-articular therapies in some OA patient populations. Conclusion: This systematic review provides an overview of the current pharmacologic options for OA, with a focus on race and ethnic differences in the use of such medical therapies.

Epidemiology of osteoarthritis: literature update 2022–2023

“…Differences in pain and function between racial and ethnic groups may be partially explained through disparities in depressive symptoms, income and related socioeconomic factors, and involvement in physically demanding occupations [6]. A rapid systematic review investigating differences in pharmacologic management of OA among racial and ethnic minorities found that nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) were more commonly used among African American compared to White participants with OA [9 ▪ ]. Importantly, the use of nonselective NSAIDs increases risk of some toxicities, including cardiovascular and gastroduodenal toxicity.…”

“…Importantly, the use of nonselective NSAIDs increases risk of some toxicities, including cardiovascular and gastroduodenal toxicity. While more expensive than nonselective NSAIDs, COX-2 selective NSAIDs carry somewhat less risk and therefore may be a better treatment option for OA patients with certain comorbidities [9 ▪ ].…”

Osteoarthritis as an Umbrella Term for Different Subsets of Humans Undergoing Joint Degeneration: The Need to Address the Differences to Develop Effective Conservative Treatments and Prevention Strategies

“…It is clear that some patients can be considered “responders” to a given treatment while others can be classified as “non-responders” (discussed in [ 84 ]). This is likely true for any number of treatment options and can likely be attributed to human heterogeneity [ 85 ], as well as disease heterogeneity and structural variation in the disease [ 86 ]. Therefore, conservative care should take into account human and disease heterogeneity in an integrated manner and should not remain as a series of “non-effective/effective” interventions that are implemented individually or sequentially until the time for a joint replacement!…”