2230: Racial and Ethnic Disparities in Rheumatoid Arthritis-Associated Interstitial Lung Disease and Their Impact on Antifibrotic Therapy

Background/Purpose: Rheumatoid arthritis-associated interstitial lung disease (RA-ILD) is a significant cause of morbidity and mortality among patients with rheumatoid arthritis (RA), often leading to progressive pulmonary function decline. Although antifibrotic therapies, such as pirfenidone and nintedanib, are being used in managing RA-ILD, disparities in their use and clinical outcomes persist across different racial and ethnic groups.

Methods: This retrospective study analyzed data from the BCM ILD Registry with 215 CTD-ILD patients in total. FVC and DLCO values were compared across racial/ethnic groups (White, African American, Hispanic/Latino, others). ANOVA and Ridge regression are used to examine pulmonary function differences and predictors of antifibrotic use.

Results: Within RA-ILD group, the cohort was racially and ethnically diverse: 45.2% Hispanic, 16.1% White, 12.9% Black, and 22.6% Multiracial. The mean FVC and mean DLCO were lowest in Hispanic and Black patients, respectively. Mean FVC for Hispanic patients was 50.5%, and mean DLCO for Black patients was 45.2%, while White patients had the highest mean FVC of 61.25% and mean DLCO of 50.59%. 67% of African American and Hispanic/Latino patients did not receive pirfenidone or nintedanib despite severe impairment. ANOVA showed significant differences in FVC and DLCO, with White patients showing better pulmonary function. Ridge regression analysis identified race/ethnicity as a significant predictor of antifibrotic therapy use, with minority patients less likely to receive treatment even after adjusting for disease severity.

Conclusion: Racial and ethnic disparities in RA-ILD care contribute to unequal access to treatment, resulting in poorer pulmonary outcomes for minority patients. These disparities are likely influenced by socioeconomic, and healthcare access factors, including lack of insurance, limited access to healthcare providers, and underrepresentation in clinical trials. To address these gaps, actions are needed such as expanding healthcare coverage, enhancing clinical trial representation, and providing cultural competence training to healthcare providers.