{"doi":"10.1002/art.41306","title":"Widening Disparities Among Patients With Rheumatic Diseases in the <scp>COVID</scp>‐19 Era: An Urgent Call to Action","abstract":"Recent data from multiple public health departments across the US emphasizing the disproportionate burden of coronavirus disease 2019 (COVID-19) infections in vulnerable populations serve as an urgent call to action (1, 2). As rheumatologists, we are acutely aware of the higher morbidity and mortality rates, and for a number of the diseases we treat, the higher incidence and prevalence among racial/ethnic minorities and individuals of lower socioeconomic status (SES) (3-6). Comorbidities are frequent, timely access to subspecialty care is limited, receipt of high-quality care is less common, and care is more often fragmented, with frequent, avoidable acute care use (7, 8). Among patients with systemic lupus erythematosus (SLE), where these disparities have been shown to be particularly pronounced, prolonged glucocorticoid use and delayed or lack of standard-of-care immunosuppressive use is common, and hydroxychloroquine (HCQ), the backbone of SLE therapy to prevent flares and organ damage, is underprescribed and adherence is suboptimal (9). In addition, despite an at least 2–3-fold higher prevalence of SLE and significantly poorer outcomes, African American individuals are much less likely to be enrolled in clinical trials compared to white individuals (10, 11). Structural racism, historic injustices in research, implicit bias by health providers, and ongoing experiences of discrimination contributing to patient distrust all contribute to this under-enrollment (10, 11). As a result, we often recommend treatments that have not been well-studied in the populations that may need them the most. Experiences of racial discrimination have also been associated with increased rheumatic disease activity and greater organ damage (12). A significant proportion of individuals with systemic rheumatic diseases receive immunosuppressive therapy at some point during their disease course, and these medications combined with patients’ underlying autoimmune conditions increase their susceptibility to severe infection. Among patients with SLE, particularly those insured by Medicaid (the largest public health insurer of low-income Americans), serious infections requiring hospitalization are common and African Americans are more likely than white individuals to experience them (13). The COVID-19 pandemic has already begun to disproportionately affect African American, Hispanic, and American Indian individuals, and individuals of lower socioeconomic status, and we expect that among patients with rheumatic diseases, the disparities will be even more pronounced (1, 2). Many of these individuals have more severe manifestations and less well controlled rheumatic diseases at baseline and may not be able to follow social distancing recommendations due to crowded or unstable living situations and financial constraints. In addition, more frequent glucocorticoid use among patients who lack sustained access to high-quality outpatient care not only heightens the risk for infection, but also causes cardiovascular disease and diabetes, known risk factors for poorer outcomes from COVID-19 (9, 13, 14). These factors raise significant concern for our most vulnerable patients in terms of short-term infection risk and both short-term and long-term control of their rheumatic disease. HCQ is now being promoted as a potential treatment for COVID-19, which has resulted in medication shortages for our rheumatologic patients. Medicaid limits patients to 1-month supplies of their medications. This means that our most vulnerable patients are also those least likely to have a sufficient supply. Recently, MassHealth, Massachusetts’ Medicaid organization which covers nearly 2 million residents, waived this 1-month supply limit, and other states including Illinois, Indiana, and Ohio have attempted to preserve HCQ access for rheumatology patients. An insufficient supply of essential medications, combined with potentially more severe disease and delays to initial care at the outset","journal":"Arthritis & Rheumatology","year":2020,"id":105423,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":23,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9447,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":298585,"name":"Rosalind Ramsey‐Goldman","orcid":"0000-0001-8712-787X","position":1,"is_corresponding":false},{"id":388933,"name":"Candace H. Feldman","orcid":"0000-0002-4980-9770","position":0,"is_corresponding":true}],"reference_count":16,"raw_metadata":null,"created_at":"2026-07-18T23:12:17.683386Z","pmid":"32379381","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}