Race as a determinant of clinical characteristics, treatments, and outcomes of axial spondyloarthritis in the United States

Axial spondyloarthritis (axSpA) is a chronic, inflammatory, immune-mediated disease characterized by inflammation of the axial skeleton, peripheral joints, and entheses. Patients with axSpA often experience a long diagnostic delay, and if left untreated, axSpA can lead to a substantial disease burden and permanent disability. In the US, axSpA is more commonly reported in White individuals than non-White individuals because of its strong association with the HLA-B27 allele, which is more common in White populations and certain Native American tribes. Underrecognition of the disease in non-White patient groups may contribute to underreporting of prevalence, diagnostic delay, undertreatment, and unnecessary disease burden in these patient populations. The goal of this review is to increase awareness and educate healthcare professionals on axSpA in non-White patients by reviewing epidemiology, diagnostic delay, genetic aspects, disease presentation, and treatment disparities among non-White patient populations in the US to promote timely recognition and treatment of axSpA in these patients.