Grant: Team Gr.: Embr. Diversity to Achieve Precision/Health Equity-Infection/Immunity

Inflammatory arthritis conditions such as rheumatoid arthritis, psoriatic arthritis, spondyloarthritis and juvenile idiopathic arthritis are chronic autoimmune inflammatory conditions that result in destruction of joints. While scientists have investigated genetic risks, immune system changes and possible environmental factors that trigger the onset of joint swelling, we still do not have enough knowledge to predict who will develop these conditions, nor how severe their disease will become. We do know that Indigenous Peoples experience twice the rate of these conditions, and typically experience the most severe disease relative to other population groups. Indigenous communities where we have established relationships in clinical care and research have agreed to partner with us to understand factors that increase the risk for severe arthritis, what factors are protective against developing arthritis, and how we can improve the arthritis care delivered to achieve holistic health and wellness. There are two parts to this research. The first is to perform community-based screening for inflammatory arthritis conditions. People who are deemed to be high risk for evolving to having rheumatoid arthritis will be offered a prevention strategy. In the second part we will implement a patient centered approach to help inform treatment choices that align with values and preferences. We will use shared decision making strategies to support people as they decide about preventive treatment, the appropriate treatment for their inflammatory arthritis disease activity including alternatives to western medicine, and when to start reducing or discontinuing medications. We will also develop and implement Indigenous community-based care models that meet the holistic health needs of patients. These models will meet people where they are at, and we will determine if they are able to close outcome gaps that exist for particular population groups relative to the general population.