Introduction to special section: Disparities in rheumatic diseases


In this issue of Arthritis Care & Research, we present the second in a series of themed issues. These themed issues, which appear once or twice a year, are designed to highlight state-of-the-art information in a field of relevance to rheumatology. The topic for this themed issue is disparities in the rheumatic diseases. A solicitation for manuscripts for the third theme, concerning cost and social and psychological impact of the rheumatic diseases, has already been published in the Journal.

The manuscripts submitted for the themed issue navigate the usual peer-review process of Arthritis Care & Research and therefore meet the same rigorous standards as the other articles in this or any other issue. The present issue contains 8 original articles and 2 editorials in response to the solicitation for manuscripts related to disparities in the rheumatic diseases.

In December 2000, the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NAIMS), with the participation of other branches of the NIH, federal agencies outside of the NIH, and private organizations such as the Arthritis Foundation and the American College of Rheumatology, convened a meeting devoted to research on disparities in the rheumatic diseases. An article in Arthritis & Rheumatism (Jordan J, Lawrence R, Kington R, Fraser P, Karlson E, Lorig K, et al. Ethnic health disparities in arthritis and musculoskeletal disease: report of a scientific conference. Arthritis Rheum 2002;46:2280–6) summarizing the deliberations of the meeting stated:

“Future research needs to move beyond description and attempt to understand the mechanisms for the disparities, be they genetic, environmental, cultural, behavioral, societal, or a combination of factors. Interventions need to be tested for their efficacy, effectiveness, and cost-effectiveness in eliminating the gap. The challenge to move research and practice forward in the next decade is daunting, and the stakes are high.”

The articles in this current issue do begin to meet the challenges that were posed by the 2000 conference. In some instances they accomplish this goal using much more sophisticated methodologies than were available at the beginning of the decade, and in others by reporting on research using more comprehensive data sources developed over the last several years. Another article summarizes the burgeoning literature using the tools of systematic review; still another reports on the results of an intervention. Yet one more summarizes the deliberations of a conference designed to develop novel explanations for the sex disparity in one condition.

Several disease entities are examined in this issue; 5 articles concern the topic of systemic lupus erythematosus, 1 concerns osteoarthritis, 1 concerns arthritis by self-report, and the last concerns conditions that are indications for total knee replacement. The editorials that introduce this themed issue provide a valuable assessment of the progress made between 2000 and the present, and both editorials outline an agenda to continue that progress.

We can only hope that special conferences and themed issues on disparities in the rheumatic diseases will not have to be repeated far into the future. However, although progress since the NIAMS conference in 2000 has been palpable, that hope does not seem near to fulfillment.