Where You Live Shouldn't Dictate Your Care: Multilateral Strategies Are Needed for National and Regional Equity in Psoriatic Arthritis Treatment

The cross-sectional study by Banbury et al in this issue of Arthritis & Rheumatology, entitled, "Where we live matters: varied disease burden and treatment in psoriatic arthritis in the United States" used the Rheumatology Informatics System for Effectiveness (RISE) registry to assess the clinical characteristics, social deprivation, insurance coverage, and medication use among patients with psoriatic arthritis (PsA) across different regions of the United States. 1 This article reveals disparities in PsA care at a time when new therapies and medications are continuously being developed.To ensure equitable outcomes for vulnerable populations, it is critical that advanced therapies be distributed effectively across regions, practice settings, and insurance types, especially as current legislation may lead to millions of Americans losing health insurance coverage.2 Overall, Banbury et al found the cohort was composed of a higher proportion of women (58%) than men.Women with PsA were more likely to have high disease activity (HDA) and high multimorbidity compared to men yet were less likely to receive biologic disease modifying antirheumatic drugs (bDMARDs).In addition, Black patients with PsA, those with Medicare or Medicaid, and those who clustered within Medicaid-serving provider practices all had greater odds of HDA.Regionally, patients residing in the South and the Midwest had greater odds of HDA compared to those in the West and Northeast.When controlling for age and sex, patients in the Northeast had the lowest odds of HDA compared to the other regions.The authors also found regional differences in treatment practices.The Midwest had the lowest use of bDMARD therapy but the highest use of glucocorticoids and conventional synthetic DMARDs.Patients seen in RISE practices in the South and the Midwest had overall higher socioeconomic deprivation, as measured by the Area Deprivation Index (ADI), which may have contributed to decreased access to