Health inequalities in SLE: A global challenge

Prof Ian Bruce, Pro Vice Chancellor, Faculty of Medicine, Health and Life Sciences, Queen’s University Belfast; National Institute for Health Research Senior Investigator Emeritus; and Professor of Rheumatology, University of Manchester, UK, delivered a thought-provoking talk about health inequalities in systemic lupus erythematosus (SLE) at the Irish Society for Rheumatology 2026 Autumn Meeting. His central message was that outcomes in SLE are influenced not only by disease biology and clinical management, but also by social determinants, health inequalities, and wider inequities that affect life expectancy, the health conditions people experience, and the care and support available to them.

“If you walk a mile from here [Belfast city centre] in two different directions, your life expectancy at birth will differ by up to 10 to 12 years,” Prof Bruce said, as an example of the striking effects of socio-economic deprivation gaps between regions.

“I suspect if you do the same in Dublin, you would see the same thing.”

Presenting the global epidemiology of SLE, Prof Bruce introduced evidence challenging the long-held belief that the disease is rare among native sub-Saharan and East African populations. Although global epidemiological data remain limited, current indications in fact suggest a particularly high prevalence across these regions, he said.

US research also shows higher rates of SLE among several racial and ethnic groups – including Black, indigenous, and Hispanic populations.

Prof Bruce also said that these cohorts experience higher rates of lupus nephritis, end-stage renal disease, and mortality. Poverty, deprivation, discrimination, and other determinants can further worsen outcomes for these groups.

Prof Bruce also highlighted major disparities in access to diagnostics and specialist lupus care globally. He told the conference that Kenya has approximately one rheumatologist per 10 million people, while Nigeria has only 29 rheumatologists for around 220 million people. Poverty combined with limited access to diagnostic services, renal biopsy, and medical care further compounds these inequalities, attendees heard.

“We now have EULAR [European Alliance of Associations for Rheumatology] treatment guidelines and an incredible array of drugs approved for lupus, but the elephant in the room is cost,” Prof Bruce said, explaining that treatment could potentially consume an entire monthly wage in Kenya. This limited affordability restricts access to these medications and leads to greater reliance on glucocorticoids for disease control, he said. High-dose steroids ultimately increase serious infection risk, with Kenya experiencing three times the UK incidence.

Prof Bruce ended by emphasising that “SLE really is a global challenge” in rheumatology.

“Around 85 per cent of the world’s population live in low- and middle-income countries, meaning the vast majority of people with lupus live in these settings,” which are often impacted by inequality, he said.

Prof Bruce also advocated for more “inclusive research” in SLE, saying: “The disease disproportionately affects minoritised populations who remain under-represented in clinical trials; therefore, it’s very hard to make inferences about how treatment is working across different populations.”

Improving inclusion requires practical support for participants, culturally competent healthcare professionals, better reporting of ethnicity, registries and real-world data, and meaningful patient and public involvement in study designs, he concluded.