Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Int J Circumpolar Health. 2023 Dec;82(1):2166447. doi: 10.1080/22423982.2023.2166447.
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.
类风湿关节炎（RA）管理的进展显著改善了该疾病的临床结局；然而，一些患有 RA 的北美原住民（INA）并未达到其他人群观察到的高治疗成功率。我们回顾了导致 INA 患有 RA 长期预后不良的因素。我们对评估 INA 中 RA 的研究进行了叙述性综述，并补充了关于临床结局和医疗保健利用的区域行政健康和临床队列数据。我们讨论了与在 INA 人群中进行研究相关的因素，包括 RA 预防研究。患有 RA 的 INA 人群具有较高的遗传和环境易感性风险因素负担，这些因素可能会影响疾病表型、限制或延迟获得风湿病护理和先进治疗的机会。这些因素可能导致观察到的持续性滑膜炎、过早的终末期关节损伤和死亡率增加。需要新的护理模式，这些模式具有文化敏感性，并解决为居住在偏远社区且难以获得医疗服务的患者提供专业护理所面临的挑战。与 INA 社区建立尊重的研究伙伴关系的进展为解决护理差距的持续举措奠定了基础，包括旨在预防 RA 的举措。本综述强调了在 INA 人群中诊断、治疗、最终可能预防 RA 方面的一些挑战。
