Extending Service Beyond Active Duty: Generalizability of Rheumatoid Arthritis Research Conducted Among U.S. Veterans

Biomedical research involving United States Veterans continues to advance healthcare beyond the Veterans Health Administration. This is particularly true in rheumatoid arthritis (RA), where Veteran-centric research has uncovered novel insights into pathogenesis, risk factors, and disease manifestations, informing clinical care and research across both Veteran and non-Veteran populations. This includes clinical trials and epidemiologic studies in cardiovascular disease, frailty, glucocorticoid use and complications, malignancy, medication adherence, mental health, metabolic comorbidity, mortality, multi-morbidity, osteoporosis, RA-associated interstitial lung disease, sex differences in treatment response, and smoking or other environmental interactions. Given the unique characteristics of the Veteran population, the generalizability of Veteran-centric research findings towards other populations has been questioned. While there are certain exposures specific to the Veteran population (i.e. burn pits, toxic exposures), most RA research objectives in Veterans, including those listed above, are equally relevant to the non-Veteran population and their generalizability across these groups should be carefully considered. The aim of this review is to compare findings between Veteran and non-Veteran populations, demonstrating and supporting the generalizability of this research.