The cross-sectional study by Banbury et al in this issue of Arthritis however, this study adds regional variations as a potential factor. This phenomenon may be attributed to a myriad of issues such as closure of local pharmacies, delivery limitations for bDMARDs in rural areas, or differences in Medicaid expansion across regions and states. However, even regional differences may be mitigated by insurance status. For example, a study of US veterans with rheumatoid arthritis showed smaller variations in bDMARD use between rural and urban dwelling patients. This is likely due to the more homogenous insurance coverage by the Veterans Affairs system compared to other payers.11 The 2018 ACR guidelines on PsA management stress the importance of early identification and initiation of therapy for improving long-term outcomes.12 Notably, the recommendations focus on immunomodulatory agents, such as DMARDs, for long-term management rather than addressing acute symptoms through intra-articular injections or systemic glucocorticoids. Similarly, in treatment-naive patients with active PsA, the use of tumor necrosis factor inhibitors is recommended over oral small molecules as a first-line option, especially in severe presentations. In addition, given the chronic and heterogenous nature of PsA, the use of bDMARDs and, more importantly, the individualization of PsA therapy is important. This necessity for personalized treatment plans emphasizes the importance of addressing regional medication access challenges in PsA care. Although the RISE registry highlights regional differences in the distance traveled to clinical rheumatology practices, regional differences in pharmacy access may also contribute to differences in bDMARD prescribing practices. Approximately 15.8 million people (4.7%) in the US live in pharmacy deserts, encompassing both rural and urban settings.13 Prior studies have illustrated these pharmacy deserts and their impact on observed disparities in treatment patterns. For example, the higher prevalence of pharmacy deserts in the Midwest and South were significantly associated with COVID-19 deaths during the pandemic (Figure 1).14 Moreover, neighborhood-level indices, like the ADI or the Social Vulnerability Index (SVI), may be used as tools to identify neighborhoods with disparities in PsA detection, treatment, and management. Greater socioeconomic disadvantage as measured by the SVI has been shown to be associated with lower screening rates for various conditions including cancer.15 Therefore, beyond provider practice settings, disparities in pharmacy access, social vulnerability, and screening may underlie the regional differences in access to medications. This study effectively identifies disparities and regional variations in treatment patterns in the US and offers a timely emphasis on the importance of addressing systemic barriers to care in PsA treatment. Systemic factors such as access to rheumatology practices and social deprivation are major drivers of care differences. Although systemic factors that influence geographic differences in prescribing patterns are critical to inform policy, individual-level provider/patient interactions can also impact disparities in care. This study highlights the importance of considering PsA across genders and racial and geographic groups for differences in treatment culture. Efforts to address these disparities will require interventions that encompass both individual and community-wide factors. Leveraging continuing medical education opportunities by national and regional rheumatology societies could ensure more uniform, evidence-based long-term PsA management and improved outcomes. Likewise, future studies investigating variables such as time to diagnosis and time to DMARD may be beneficial to provide a holistic assessment of treatment variations and equip individual providers with useful metrics to mitigate disparities within their own practice. All in all, the data presented by Banbury et al underscore the national and regional disparities faced by patients with PsA. It will be through integrative and multilateral approaches that we achieve equitable care for this patient population. No original data were shared in this editorial. Data for the figure can be downloaded from the US Census Bureau. All authors contributed to at least one of the following manuscript preparation roles: conceptualization AND/OR methodology, software, investigation, formal analysis, data curation, visualization, and validation AND drafting or reviewing/editing the final draft. As corresponding author, Dr Blanco confirms that all authors have provided the final approval of the version to be published and takes responsibility for the affirmations regarding article submission (eg, not under consideration by another journal), the integrity of the data presented, and the statements regarding compliance with institutional review board/Declaration of Helsinki requirements. Disclosure form. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. 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Hwang et al. (Thu,) studied this question.