Incarcerated Individuals with Rheumatic Conditions

Additionally, it is well-established that psychosocial stressors can exacerbate rheumatic diseases, and prisons are inherently high-stress environments, with conditions that promote social isolation, limited autonomy, overcrowding, fear of violence and harm, and poor sleep. Depression, which is known to have a negative impact on rheumatic disease and contributes to flares, is common among prisoners, with one systematic review reporting a prevalence of up to 29%.^16,17

These issues are compounded by frequent transfers between facilities, which can disrupt continuity of care and put patients at risk of lapses in medication adherence and follow-up care.

Perhaps most concerning, given the immunocompromised state of many patients undergoing treatment for rheumatic conditions, is their heightened risk of infectious diseases, such as tuberculosis, due to overcrowding, poor ventilation, inadequate sanitation and substandard disease surveillance, which further jeopardizes their health.¹⁸

What Can We Do?

Addressing these issues requires a comprehensive, multidisciplinary approach that prioritizes policy reform, improved healthcare coordination and greater advocacy for incarcerated individuals with rheumatic conditions. Under the Eighth Amendment, incarcerated individuals are entitled to adequate medical treatment, including care for chronic rheumatologic conditions, yet structural barriers often prevent access to necessary treatment.

Solutions must include:

• Expanding telemedicine while ensuring in-person specialist access when needed;
• Implementing standardized treatment protocols; and
• Providing specialized training for prison healthcare staff.

Efforts must focus on improving healthcare access, continuity and coordination within correctional facilities, while also raising awareness about the unique needs of incarcerated individuals with rheumatologic conditions.

Policymakers should advocate for expanded medication formularies, improved oversight of prison healthcare systems and the integration of electronic health records across facilities to maintain continuity of care.

Researchers and advocacy organizations must work to highlight the unique challenges this population faces, pushing for evidence-based policy changes that ensure equitable healthcare access.

By fostering collaboration among healthcare providers, policymakers and correctional institution staff, we can create meaningful reforms that improve the management of chronic rheumatic diseases in correctional settings.

Katherine Terracina, MD, is an assistant professor at UT Health Houston, McGovern Medical School, where she is an active clinician specializing in general rheumatology, as well as a clinician educator deeply committed to training the next generation of physicians. She is a member of the ACR’s Committee on Ethics and Conflict of Interest.

Prajakta P. Masurkar, PhD, MPharm, is a health economics and outcomes research associate director at UCB Inc., specializing in evidence generation for payers in rheumatology and dermatology diseases, including psoriasis, psoriatic arthritis, hidradenitis suppurativa and more. She is a member of the ACR’s Committee on Ethics and Conflict of Interest.