Reconsidering Race-Based Medicine in Pediatric Rheumatology: Challenges and Opportunities for Equitable Care

Area of Science:

• Pediatric Rheumatology
• Health Equity Research
• Clinical Practice Guidelines

Background:

• Race-based practices persist in pediatric rheumatology, influencing diagnosis and treatment.
• These practices often rely on flawed assumptions of biological differences, exacerbating health inequities.
• Existing guidelines may perpetuate disparities by not adequately addressing social determinants of health.

Purpose of the Study:

• To examine the limitations of current race-based practices in pediatric rheumatology.
• To highlight how these practices contribute to misdiagnosis and delayed treatment.
• To advocate for a transition to race-conscious, equity-focused approaches in clinical care and research.

Main Methods:

• Literature review of race-based practices in pediatric rheumatology.
• Analysis of clinical decision-making processes, including laboratory result interpretation.
• Examination of disease-specific examples like Kawasaki disease and MIS-C.

Main Results:

• Race-adjusted formulas for eGFR, pulmonary function, and creatine kinase can lead to misdiagnosis, particularly in Black and Asian children.
• Race-based assumptions in diagnosing and treating conditions like Kawasaki disease and MIS-C can result in incorrect assessments of severity and efficacy.
• Current practices reinforce health disparities rather than mitigating them.

Conclusions:

• A shift from race-based to race-conscious practices is essential in pediatric rheumatology.
• Incorporating social determinants of health and recognizing clinical biases are crucial for equitable care.
• More inclusive research and diverse clinical trial participation are needed to improve generalizability and outcomes for all children.