Autoimmune rheumatic disease in Australian Aboriginal & Torres Strait Islander Peoples: What Do We Know?
Autoimmune rheumatic disease (AIRD) designates a group of chronic inflammatory autoimmune illnesses, which includes lupus and rheumatoid arthritis among others. Lupus is known to be more common and more severe in Aboriginal and Torres Strait Islander Peoples. However, very little is currently known about other AIRD such as rheumatoid arthritis and psoriatic arthritis, in this population.
A review recently published by Monash researchers in collaboration with The Queen Elizabeth Hospital (Adelaide), Alice Springs Hospital, Primary and Public Health Care Central Australia and The Royal Prince Alfred Hospital summarises what is currently known about AIRD other than lupus in Aboriginal and Torres Strait Islander Peoples, and highlights gaps in knowledge where future research is needed.
There is very little published data regarding AIRD other than lupus in Aboriginal and Torres Strait Islander Peoples. For example, the largest case series of rheumatoid arthritis, which is estimated to affect approximately 1% of the general Australian population, only includes 18 patients. It is unclear as to whether this is because these illnesses are less common, under-diagnosed, and/or under-reported in Aboriginal and Torres Strait Islander Peoples. There is no published data on outcomes of these AIRD in Aboriginal and Torres Strait Islander peoples, such as access to medications.
Think about a boat that is leaking - if no one is aware of this leak, or if someone knows there is a leak but no one knows where it is, either way, the leak can’t be fixed. As we currently don’t know much about AIRD in Aboriginal and Torres Strait Islander Peoples, we don’t know whether there are suboptimal health outcomes, or barriers to appropriate healthcare access, that need to be addressed. By finding out whether these issues exist, and if so, what they are, we could improve outcomes for Aboriginal and Torres Strait Islander Peoples suffering from AIRD in the future.
By reviewing what is currently known about these illnesses in Aboriginal and Torres Strait Islander Peoples, this research team was able to identify gaps in knowledge where further research is needed. This is the first step in helping to improve health outcomes for Aboriginal and Torres Strait Islander Peoples suffering from these illnesses. In order to progress research in this area, the team is currently planning a retrospective study, which will involve the review of medical records of Aboriginal and Torres Strait Islander patients, as well as patients not identifying as Aboriginal or Torres Strait Islander, seen in public hospital rheumatology clinics at various sites around Australia, to determine whether there are differences in the clinical presentation and outcomes of these illnesses in this group. The team also plans a prospective study to determine why lupus is more severe in Aboriginal and Torres Strait Islander Peoples.
This work has significance for Aboriginal and Torres Strait Islander Peoples affected by AIRD, including lupus, rheumatoid arthritis and psoriatic arthritis, among many others. We know that lupus is more common and severe in Aboriginal and Torres Strait Islander Peoples, with increased mortality rates compared to the general Australian population. However, very little is currently known about other AIRD in Aboriginal and Torres Strait Islander Peoples, including how many people are affected, and if their disease characteristics and outcomes differ compared to the general Australian population.
"Finding out more about AIRD in Aboriginal and Torres Strait Islander Peoples will allow us to determine if there are areas in which outcomes are currently suboptimal, where future research and management strategies could be implemented, thus leading to improved quality of life", said Laura Eades, first author and PhD student in the Rheumatology Group.
Reference:
Autoimmune rheumatic disease in Australian Aboriginal and Torres Strait Islander Peoples: What do we know? Laura E Eades, Jason Sines, Alberta Y Hoi, Ruaidhri Liddle, Rangi Kandane-Rathnayake, Eric F Morand, Stephen Brady, Maureen Rischmueller, Fabien B Vincent https://doi.org/10.1016/j.semarthrit.2023.152354
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