This project studies the clinical presentation of rheumatic diseases in an underserved, largely ethnic minority community in the Washington, DC metropolitan area. Through the NIAMS Community Health Center, subjects with rheumatic complaints are evaluated and provide clinicians with first-hand experience in understanding ethnic differences in autoimmune disease phenotypes as well as barriers to care. This project has supported research on cultural differences in understanding standardized self-report outcome assessment tools, determination of clinically important improvements in rheumatoid arthritis, use of complementary and alternative medicine in patients with rheumatic symptoms, acceptability of yoga as a treatment for arthritis by minority individuals, and understanding of the research process and informed consent among ethnic minorities. In addition, researchers have examined interventions to improve the referral process between primary care providers and subspecialists. Serological studies are currently underway to examine immune abnormalities in patients with rheumatoid arthritis and systemic lupus erythematosus.