Ethnicity Drives Unequal Steroid Use in Lupus, With Sarah Dyball, PhD

Black, Asian, and mixed-ethnicity patients with systemic lupus erythematosus (SLE) receive significantly higher oral corticosteroid (OCS) doses than White patients, according to new population-level data presented at the European Alliance of Associations for Rheumatology (EULAR) 2026 Congress in London from June 3 – 6.^1,2

The research draws on the Greater Manchester Care Record (GMCR), a linked primary care database covering approximately 2.8 million residents across 1 of the United Kingdom's most ethnically and socioeconomically diverse regions.² Investigator Sarah Dyball, MBBS, PhD, an academic clinical lecturer at the Centre for Musculoskeletal Research, University of Manchester, discussed the work in an interview with Rihards Buss, MD, consultant rheumatologist at Freeman Hospital in Newcastle, for RheumatologyLive’s Joint Ventures series.

"I think it's about what implementation measures [we can] actually practice to change some of these barriers and how do we create equity within our own care,” Dyball said. “It's so difficult to answer that question, but I think focusing on some of the things that we can address first is the next steps.”

Steroid Prescribing Disparities by Ethnicity

Dyball and colleagues’ analysis drew on a prevalent cohort of 2727 patients with SLE, roughly a third of whom were from a diverse ethnic background.³ Compared with White patients, OCS prescribing rates were significantly greater among Black patients (incidence rate ratio [IRR], 2.07; 95% CI, 1.55-2.82; P <.001), Asian patients (IRR, 1.26; 95% CI, 1.03-1.56; P =.025), and patients of mixed ethnicity (IRR, 3.85; 95% CI, 2.30-7.04; P <.001).² These disparities persisted in an adjusted regression model.

Dyball's cohort also showed greater rates of comorbidities and lupus nephritis among Black and Asian patients relative to White patients, alongside lower vaccination uptake, pointing to a broader pattern of inequitable disease burden and care beyond steroid dosing alone.

Ethnicity-Deprivation Interaction Complicates the Picture

The relationship between socioeconomic deprivation and steroid exposure was not straightforward. Dyball's data revealed a significant interaction between ethnicity and deprivation, meaning the effect of deprivation on steroid prescribing varied by ethnic group rather than following a uniform, linear trend.

Despite widespread calls at rheumatology meetings to minimize steroid exposure in lupus, Dyball noted that roughly 20% of patients in the cohort remained on long-term steroids. She attributed the gap to physician prescribing habits, unequal access to steroid-sparing agents, and structural limits within the NHS that leave access equitable in principle but not in outcome.

Dyball said the GMCR analysis offers a population-level view that complements her separate work in registry data drawn from patients with more severe disease managed in hospital settings. Her next step is qualitative research involving allied health professionals, clinicians, and patients themselves, aimed at identifying the specific modifiable barriers behind the prescribing gaps.

“We need to drill down and actually interview people on the ground—so our AHPs, clinicians, [and] patients—about what these barriers are so that we can create and implement models to actually drive forward some of these changes.”

References

1. Dyball S, Rodziewicz M, Bruce I, Parker B. Health inequalities in systemic lupus erythematosus: comorbidities, infections, and treatment patterns in a multi-ethnic UK population [abstract POS0716]. Presented at: European Alliance of Associations for Rheumatology (EULAR) Annual Congress 2026; June 3-6, 2026; London, United Kingdom. doi:10.1136/annrheumdis-2026-eular.B.1852

2. Buss R, Dyball S, and Harnden K. Joint Ventures: Lupus Health Inequalities, Growing Burden of ICI-Arthritis at EULAR 2026. RheumatologyLive. Published June 26, 2026. Accessed September 1, 2026. https://www.rheum-live.com/view/joint-ventures-lupus-health-inequalities-growing-burden-ici-arthritis-eular-2026

3. Dyball S, Rodziewicz M, Lunt M, Bruce I, Parker B. Oral corticosteroid use and patterns in patients with systemic lupus erythematosus: a population-based study using the Greater Manchester Care Record [abstract POS0309]. Presented at: European Alliance of Associations for Rheumatology (EULAR) Annual Congress 2026; June 3-6, 2026; London, United Kingdom. doi:10.1136/annrheumdis-2026-eular.B.1863