Joint Ventures: Lupus Health Inequalities, Growing Burden of ICI-Arthritis at EULAR 2026

In this episode of Joint Ventures, host Rihards Buss, MD, consultant rheumatologist, Freeman Hospital, Newcastle, sits down with Sarah Dyball, MBBS, PhD, academic clinical lecturer, Centre for Musculoskeletal Research, University of Manchester, and Kate Harnden, MBChB, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, at the European Alliance of Associations for Rheumatology (EULAR) 2026 annual congress in London.

Buss speaks with Dyball and Harnden each to learn more about their research on structural inequity in systemic lupus erythematosus (SLE) management and the emerging challenge of predicting outcomes in immune checkpoint inhibitor (ICI)-induced arthritis — both lines of research carry direct implications for how rheumatologists approach a growing and underserved patient population.

The first conversation is with Dyball, whose 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. Dyball's 2 posters at the meeting examine comorbidities, treatment patterns, and corticosteroid prescribing in a prevalent cohort of 2,727 SLE patients.¹˒² The data reveal that black and asian patients carry a disproportionate burden: higher rates of lupus nephritis, greater socioeconomic deprivation, lower vaccination uptake, and — critically — significantly higher oral corticosteroid (OCS) prescribing rates even after adjustment for confounders. Compared with white patients, OCS prescribing rates were higher among black patients (incidence rate ratio [IRR], 2.07; 95% CI, 1.55–2.82; P <0.001), asian patients (IRR, 1.26; 95% CI, 1.03–1.56; P =0.025), and those of mixed ethnicity (IRR, 3.85; 95% CI, 2.30–7.04; P <0.001).²

A significant interaction between ethnicity and deprivation adds further complexity: the relationship between deprivation and steroid exposure is not linear and varies by ethnic group. Buss and Dyball explore what drives these patterns — biases in prescribing, barriers to accessing steroid-sparing agents, the structural limitations of an NHS system that provides equity of access in principle but not always in practice. Dyball is clear that the GMCR data capture the population-level picture; the next step is qualitative work with patients and allied health professionals on the ground, to identify modifiable barriers and co-design implementation strategies. "I think it's about what implementation measures can we actually practice to change from these barriers," she notes, "and actually, how do we create equity within our own care."

The second guest is Harnden, who presents the first multivariable models developed to predict disease persistence in ICI-induced inflammatory arthritis (ICI-IA) and arthralgia.³ As checkpoint inhibitors are used across an expanding range of cancer indications, the rheumatological caseload they generate is growing rapidly. ICI-IA affects a meaningful proportion of patients and has been shown to persist in around 50% of cases even after immunotherapy cessation,⁴ but ICI-arthralgia — joint pain without overt synovitis — may be up to 6 times more common than ICI-IA⁵ and has been relatively understudied.

The Leeds cohort, now over 200 patients, is distinctive in prospectively including arthralgia patients alongside those with frank inflammatory arthritis. Among 118 evaluable patients followed for a median of 16 months, 56.5% met the primary outcome of persistent disease, with rates similar between ICI-IA and arthralgia groups. Two multivariable logistic regression models — 1 incorporating imaging, 1 clinical features only — identified tenosynovitis on ultrasound or whole-body MRI, elevated C-reactive protein, a peripheral inflammatory arthritis pattern on whole-body MRI, corticosteroid use at baseline, and age below 65 as independent predictors of persistence (area under the curve, 0.86).

Notably, whether patients had stopped immunotherapy at or before baseline was not significantly associated with persistence in this cohort — a finding Harnden describes as genuinely surprising, given that prior studies restricted to those who had already stopped therapy found roughly 50% persistence. The clinical implication is significant: continuation or discontinuation of immunotherapy alone should not guide rheumatological management decisions. Future work will focus on refining these models with biomarker data and validating them in external cohorts.

Buss, Dyball, and Harnden have no disclosures to report.

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. 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

3. Harnden K, Sharrack S, Sugden H-J, et al. Predicting the outcomes of immune checkpoint inhibitor-induced inflammatory arthritis and arthralgia: development of multivariable models to predict disease persistence [abstract POS0147]. 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.1618

4. Braaten TJ, Brahmer JR, Forde PM, et al. Immune checkpoint inhibitor-induced inflammatory arthritis persists after immunotherapy cessation. Ann Rheum Dis. 2020;79(3):332-338. doi:10.1136/annrheumdis-2019-216109

5. Abdel-Wahab N, Suarez-Almazor ME. Frequency and distribution of various rheumatic disorders associated with checkpoint inhibitor therapy. Rheumatology (Oxford). 2019;58(suppl 7):vii40-vii48. doi:10.1093/rheumatology/kez297