PT  - JOURNAL ARTICLE
AU  - Christine A. Peschken
AU  - Carol A. Hitchon
AU  - David B. Robinson
AU  - Irene Smolik
AU  - Cheryl R. Barnabe
AU  - Suraj Prematilake
AU  - Hani S. El-Gabalawy
TI  - Rheumatoid Arthritis in a North American Native Population: Longitudinal Followup and Comparison with a White Population
AID  - 10.3899/jrheum.091452
DP  - 2010 Jun 15
TA  - The Journal of Rheumatology
PG  - jrheum.091452
4099  - http://www.jrheum.org/content/early/2010/06/13/jrheum.091452.short
4100  - http://www.jrheum.org/content/early/2010/06/13/jrheum.091452.full
AB  - Objective To describe differences in phenotype and outcomes in North American Native (NAN) patients with rheumatoid arthritis (RA) followed prospectively and compared to white patients with RA. Methods Patients from a single academic center were followed over 20 years using a custom database. Data included diagnoses, year of disease onset, ethnicity, modified Health Assessment Questionnaire (mHAQ) score, patient and physician global scores, tender and swollen joint counts, treatment, serology, and erythrocyte sedimentation rate (ESR). Records of all white (n = 1315) and NAN (n = 481) patients with RA were abstracted. Cumulative treatment data and clinical measures were compared. Results Disease duration was longer in white patients compared to NAN patients (16 ± 11 vs 14 ± 10 years, respectively; p = 0.03). Onset age was 34 years for NAN patients and 43 years for white patients (p < 0.001). NAN patients were more frequently positive for rheumatoid factor (89% vs 74%; p < 0.001) and antinuclear antibody (57% vs 21%; p < 0.001). Although mean tender joint counts and swollen joint counts were similar, NAN patients had higher Lansbury scores (weighted joint count; 66.5 vs 49.7; p < 0.001), mHAQ scores (1.1 vs 0.9; p = 0.001), and ESR (31 vs 25 mm/h; p < 0.012). NAN patients had more frequent knee (53% vs 34%; p < 0.001) and elbow (62% vs 48%; p = 0.007) involvement. Compared to white patients, NAN patients took a higher lifetime number of disease-modifying antirheumatic drugs (3.2 ± 1.9 vs 2.2 ± 1.7; p < 0.001), had more combination therapy (38% vs 29%; p = 0.002), and had more frequent prednisone use (55% vs 39%; p < 0.001). Conclusion Compared to white patients, NAN patients with RA develop disease earlier, are more frequently seropositive, have greater large joint involvement, and greater disease burden, although treatment is more aggressive. These differences are present early and persist throughout the disease course.