Mark RD Johnson, Ash Samanta, Jo Samanta, Nichola Brooks
Rheumatoid arthritis (RA) is a chronic inflammatory condition that may lead to long-termdisability. An understanding of the disease by health professionals in conjunction with early intervention improves clinical outcomes. Attention to ethnic variation adds an important dimension to this understanding. International research has demonstrated considerable variability in prevalence and clinical features of RA amongst different ethnic groups. The 2001 census reveals that over 12% of the British population are classified as ethnic minorities, of which South Asians form a large group. In some areas, they form a very significant fraction of the population. In major metropolitan urban agglomerations they may form nearly a majority of the population in selected areas, as is also the case in some major provincial cities such as Leicester (where 25.7% population was said to be of South Asian Indian origin in the 2001 census). Genomic and pharmacological research in other clinical areas has revealed interesting differences between ethnic groups in the natural history of disease and the efficacy of drugs. An understanding of disease patterns in diverse ethnic groups, as well as sociocultural aspects that might impact upon health, is essential for the adequate provision of local healthcare. Published medical literature about RA pays scant attention to South Asians or other minority ethnic groups in Britain. Much of the current literature on RA in South Asians is either limited or inconsistent. The prevalence of the disease appears to be nearly as high as in the white population with similar clinical features, but we found no good studies regarding clinical outcomes. There appears to be a higher usage of complementary and alternative medication, and sociocultural perceptions of a chronic disease such as RA may limit the use or acceptance of traditional pathways that access healthcare. These factors are of fundamental importance for healthcare providers in a multicultural society such as Britain, in order to ensure an equitable service for patients with RA in the South Asian ethnic minority group. There is a need forwell-designed studies to establish how best the healthcare needs of South Asians with RA may be met. Such studies would need to include not only the more traditional clinically based approach of data collection, but would also need to incorporate psychosocial research in order to be able to understand and provide for ethnic-specific healthcare requirements. Healthcare providers in Britain must acknowledge the multiracial character of the population that they serve, and should be prepared to address the needs of these populations proactively.
