Incarcerated Individuals with Rheumatic Conditions

Access to Rheumatologic Care

Access to rheumatologic care is particularly challenging for incarcerated individuals, exacerbated by the nationwide shortage of rheumatologists, especially in rural areas. A 2015 study by the Arthritis Foundation found that 21% of adult rheumatologists were based in the Northeast, while only 3.9% practiced in the Southwest.⁶

Most specialists are concentrated in urban and suburban regions, leaving rural communities severely underserved. A disproportionate number of prisons are in rural areas, where access is severely limited.⁷ This means inmates who need to see a rheumatologist will have longer wait times—or no access at all until they are relocated to a facility in an urban area with better healthcare infrastructure.

Although telemedicine, which was first introduced in Florida’s prison system in the late 1980s and was utilized in over half of state correctional facilities by 2004, has become a vital tool for delivering healthcare, it proves more challenging in rheumatology due to the need for physical examinations to diagnose and manage musculoskeletal conditions.⁸ In rheumatoid arthritis, in particular, studies have shown there is often discordance between patient and physician tender and swollen joint counts, especially in more active and early disease.⁹ As a result, incarcerated individuals may experience significant delays in diagnosis and treatment, potentially leading to worsening disease progression, increased disability and higher long-term healthcare costs.

Addressing these disparities requires systemic changes, such as expanding specialist outreach programs, improving prison healthcare policies and leveraging emerging technologies to enhance remote assessments. For example, training prison nurses to perform physical exams under the remote supervision of a rheumatologist could be a practical solution to improve access to specialist care.

Access to Medications

Another major challenge is the accessibility of medications, which are often prohibitively expensive. Conventional synthetic disease-modifying anti-rheumatic drugs (DMARDs), such as methotrexate or mycophenolate, can cost as little as $16 per month with certain prescription-savings programs, but the overall financial burden rapidly escalates due to the need for regular lab monitoring to assess potential drug toxicity (every three to four months) and the reliance on the expertise of healthcare professionals to accurately interpret results, monitor for signs of toxicity and make appropriate changes when toxicity is seen.¹⁰

In addition, these medications are often insufficient to control disease, necessitating the use of biologic or targeted synthetic DMARDs. These therapies significantly raise costs, with annual costs through commercial insurance ranging from $43,935 to $101,402 in rheumatoid arthritis.¹¹