A groundbreaking investigation from NYU Langone Health is challenging long-held assumptions about psoriatic arthritis (PsA), revealing significant racial and ethnic disparities in disease recognition, diagnosis, and research representation.
Challenging Historical Misconceptions
Dr. Rebecca Haberman, rheumatologist and associate director of the Psoriatic Arthritis Center at NYU Langone Health, emphasizes how the traditional view of PsA as a "White disease" has created substantial barriers to proper diagnosis and treatment in non-White populations. "Psoriasis doesn't look the same on all skin tones," explains Dr. Haberman. "A lot of times psoriasis in itself can be undiagnosed or even misdiagnosed. Then, once they don't have psoriasis, the first thing that comes to mind for rheumatologists is not necessarily PsA."
Real-World Disease Prevalence
Recent data from the National Health and Nutrition Examination Survey (NHANES) contradicts the historical perception of PsA as predominantly affecting White individuals. The study, led by Dr. April Armstrong, revealed psoriasis prevalence rates of:
- 3.6% in White individuals
- 2.5% in Asian individuals
- 1.9% in Hispanic individuals
- 1.5% in Black individuals
Clinical Trial Representation Gap
A significant disconnect exists between real-world patient demographics and clinical trial populations. Current research studies typically feature over 90-95% White participants, creating a substantial representation gap that may impact understanding of disease manifestation and treatment efficacy across different ethnic groups.
Urban Center Insights
The diverse patient population at NYU Langone's network, including both private practices and public hospitals in New York City, has provided unique insights into the true face of PsA. Dr. Haberman notes that their patient population differs markedly from those typically represented in published literature, offering valuable opportunities for more inclusive research.
Moving Forward
The findings underscore the urgent need for more diverse and representative clinical trials in PsA research. Healthcare providers must also increase awareness of how PsA presents differently across various skin tones to ensure accurate diagnosis and appropriate treatment for all patient populations.
