The risk for developing rheumatoid arthritis (RA) is associated with many factors, including genetics and environmental conditions. People of some races and ethnicities are more likely than others to develop RA or to experience more severe RA. Since race and ethnicity can influence health in many ways, details of the connection between race and ethnicity and risk for RA are not fully clear.

Genetics vs. Race

Traditionally, some researchers have assumed that diseases that appear linked to race and ethnicity also share a genetic link. However, research increasingly indicates that there is no genetic basis for race.

That said, research does show a correlation between some genes that suggest increased risk for RA in certain Native American groups. Studies also show genes that appear to protect against RA are more prevalent among people of Northern European and Japanese descent. This may explain some of the risk differences among these racial groups.

Race, Ethnicity, and Risk for Developing RA

Studies show that some people of some races and ethnicities are more likely to develop RA.

Globally, certain Native American tribes (Pima and Chippewa) seem to have the highest risk of developing RA.

According to the Journal of Clinical Medicine, non-Hispanic African Americans have a higher risk of developing RA compared with non-Hispanic Caucasians. Other research has found low occurrences of RA in people from Southeast Asia, including China and Japan.

Studies show that, between 2005 and 2018, RA diagnoses increased among Hispanic people in the United States. It’s unclear what is behind this uptick in diagnosis among this population.

Race, Ethnicity, and RA Symptom Severity

The severity of RA symptoms also varies across different racial and ethnic groups. In the U.S., Hispanic people appear to experience increased disease severity when compared to non-Hispanic white people, according to a study from the American Journal of Medicine. Non-Hispanic African Americans also appear at risk for more severe RA symptoms when compared to non-Hispanic white Americans, per the Journal of Clinical Medicine.

There are different ways to measure severity in cases of RA, including disability, pain, function, and achievement of remission — a state when people with RA feel better and symptoms improve.

Studies have shown:

• African Americans appear to achieve remission less often than white people.
• Both Hispanic and African Americans report greater degrees of disability and pain resulting from their RA when compared to white people.
• African Americans and Hispanic Americans reported worse functional status than white people.
• One study shows Asian Americans are likely to report less severe pain than people non-Asian Americans.

Overall, researchers have found that white and Asian people appear better able to achieve remission, less pain, and better daily functionality when compared to Black and Hispanic people. The reasons for these differences may result from a complex combination of factors.

Researchers have found that stress is linked to autoimmune and rheumatic diseases. Some theorize that African Americans and Hispanic Americans, who are more at risk for disadvantaged socioeconomic status, are more at risk for severe RA due to the stress of experiencing poverty and disability.

Differences in Treatment

Early referral to a rheumatologist and early treatment with disease-modifying antirheumatic drugs (DMARDs) is shown to improve the long-term outcomes in people with RA. For this reason, delays in diagnosis or treatment can affect how severe RA becomes and how it progresses over time.

Studies show that:

• Black Americans with RA are less likely to receive treatment with DMARDs compared to white Americans.
• Black Americans are less likely to receive appropriate treatment for chronic pain.
• Black Americans are less likely to have access to health insurance and primary health care.

Choice of DMARD may also differ along racial lines. One study examined preferences in DMARDs among Americans with RA. For the study, participants were asked to identify themselves as Black or white. The results showed that 51 percent of white people preferred a more aggressive, but more toxic, DMARD over a less aggressive but less toxic alternative. By contrast, 16 percent of the Black participants opted for the more aggressive treatment.

Diversifying Research and Rheumatology

More research is needed in order to understand why some people of particular racial and ethnic groups are more at risk for developing RA and experiencing more severe symptoms. The question is further complicated by the fact that people of color are underrepresented in clinical trials for RA and genetic research as a whole. Efforts are underway to better understand the reasons behind the lack of diversity in clinical research and how to ensure that trial participation will be more diverse and inclusive in the future.

Rheumatology is one of the least diverse fields of medicine, with only an estimated 25 percent of people of color among providers in the United States. However, the American College of Rheumatology has announced plans to actively recruit trainee doctors with more diverse backgrounds into rheumatology programs going forward.

Talk With Others Who Understand

On myRAteam, the social network for people with rheumatoid arthritis and their loved ones, more than 181,000 members come together to ask questions, give advice, and share their stories with others who understand life with rheumatoid arthritis.

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