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A Critical Look at Race-Based Practices in Rheumatology Guidelines.

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Rheumatology guidelines lack clear race definitions and often use oversimplified categories, potentially harming patient care. Standardized race reporting is urgently needed to ensure accuracy and address disparities.

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Area of Science:

  • Rheumatology
  • Clinical Practice Guidelines
  • Health Equity

Background:

  • Race and ethnicity are frequently discussed in rheumatology.
  • However, their incorporation into clinical practice guidelines requires critical evaluation.

Purpose of the Study:

  • To assess how race is defined and utilized in rheumatology practice guidelines.
  • To identify inconsistencies and potential biases in race-based recommendations.

Main Methods:

  • Systematic review of American College of Rheumatology (ACR) and European Alliance of Associations for Rheumatology (EULAR) guidelines published 2010-2020.
  • Thematic analysis of race and ethnicity terms within diagnostic and treatment recommendations.

Main Results:

  • Only 25% of reviewed guidelines (16 of 65) used race terms, with no clear definition provided.
  • Race was often conflated with ethnicity/ancestry, using oversimplified and exclusionary categories.
  • Recommendations based on limited racial diversity may not be generalizable and can perpetuate stereotypes.

Conclusions:

  • Urgent need for standardized race reporting in rheumatology guidelines.
  • Recommendations to improve consistency, mitigate conflation, reanalyze race-based tools, and address structural causes of disparities.