Rheumatic disease in Canada's Northwest Territories: baseline review and comparative insights.

Abstract

This study captures baseline demographic and rheumatologic history of patients from Canada's Northwest Territories (NWT) to improve disease burden understanding, identify potential at-risk populations, and highlight care gaps in a unique and underserved population. In this descriptive study, we collected retrospective data on patients referred from the NWT to Edmonton, Alberta, in 2022-2023, when all established and newly referred rheumatology patients from this region were redirected to receive care in Edmonton. Diagnoses were compared to a 2022-2023 Edmonton rheumatology new-patient cohort. There were 425 patients (70% female) representing 30 communities. Of the 250 patients with documented ethnicity, 69.6%, 25.6%, and 4.8% were of Indigenous, White, and Other descent (including people of Asian and African descent), respectively. The most frequent inflammatory rheumatologic diagnoses among new referrals were rheumatoid arthritis (27.8%), gout (13.9%), and psoriatic arthritis and ankylosing spondylitis (11.1% each, vs. ~ 7% each in the Edmonton-based cohort). There were no new vasculitis cases in the NWT cohort compared to 9.2% of new diagnoses in the Edmonton cohort. Twenty-one percent of patients missed their appointments, and 43% of previously established patients had active disease. This represents the broadest epidemiologic dataset for NWT patients with rheumatologic diseases, with higher observed proportion of ankylosing spondylitis and psoriatic arthritis and lower observed proportion of vasculitis, compared to the Edmonton cohort. NWT patients face unique barriers around geographic location, transportation, and care delays, compounded by active disease that may disproportionately affect female and Indigenous patients. Key Points • This study provides the broadest epidemiologic dataset of patients with rheumatologic diseases in the Northwest Territories and is the first to comprehensively differentiate between various rheumatologic diseases seen in this population. • There appears to be a higher observed proportion of psoriatic arthritis and ankylosing spondylitis, as well as a lower observed proportion of vasculitis, in patients from the NWT. This may reflect the heterogeneity of the population as well as heterogeneity among different Indigenous groups, but confirming and explaining these patterns requires further exploration. • This study further re-emphasizes known barriers that patients from the NWT face, including geographic location, transportation access, and delays to specialist care, all compounded by active disease that frequently requires medications that can only be prescribed by the respective specialist. • These limitations may disproportionately affect female and Indigenous patients.