Research undertaken by Dr Chunhuan Lao for Arthritis NZ’s inaugural Lupus/SLE Postdoctoral Fellowship is transforming our understanding of systemic lupus erythematosus (lupus).
Awarded our Fellowship in mid-2022, Dr Lao from the University of Waikato’s Division of Health, brought together national health datasets, clinical expertise, and cultural insight to provide the clearest picture yet of who is affected, how the condition is treated, and the real impact it has on people’s lives. More broadly, Dr Lao’s career to date has focused on researching chronic diseases and improving health equity in New Zealand.
Her research findings show that while lupus is relatively uncommon in this country, its impact is significant. It affects women far more than men, with around 65 women per 100,000 living with lupus compared with about 8.5 men per 100,000 (or average “prevalence”).
An important finding is that lupus does not affect all communities equally. Pacific people for example have the highest rates - more than three times those seen in European populations - and Māori are also disproportionately affected. These inequities extend beyond diagnosis to outcomes, meaning that some communities experience a much heavier burden of disease.
Lupus is not just a chronic condition. Sadly, people with lupus are four times more likely to die than the general population, and lupus itself is the leading cause of death among those affected. Māori experience poorer survival outcomes than other ethnic groups, highlighting a need for more equitable care for these patients.
Dr Lao also examined how lupus is treated across the country and found important differences in care. While medications such as hydroxychloroquine are widely used, adherence (ie. continuing to take medication regularly) is lower among men and Māori, suggesting that some people may not be getting the full benefit of treatment which is available.
Steroids such as prednisone are commonly used long-term, and many patients over the age of 40 also require treatments to protect bone health. Overall, treatment patterns vary depending on ethnicity, age, gender, and socioeconomic factors.
Beyond its impact on personal health and wellbeing, lupus also places a significant burden on the health system, costing New Zealand around $12 million each year.
Patients who develop end-stage kidney disease however cost around nine times more to treat than those without this complication. This finding is crucial: it shows that investing in early diagnosis, better treatment, and prevention could reduce both patient and financial costs in the long term.
Additionally, the research has confirmed that for those living with lupus, the condition is often complex, unpredictable, and extremely serious. It also highlights the need for earlier diagnosis, consistent treatment, and ongoing monitoring for complications such as kidney disease and cancer.
Arthritis NZ Research Manager Dr Richard Griffiths said Dr Lao’s Lupus/SLE research programme has been invaluable given this form of arthritis has been previously under researched in New Zealand.
“We’ve been needing to start filling in the research gaps for some time. We were grateful to receive an amazing bequest a few years ago which meant we could start facilitating new research into lupus."
“This research was undertaken full-time over a three year period. We know it has also encouraged and inspired others in the arthritis research community to look at lupus, including a Summer Scholarship funded by our organisation on the impact of lupus on Pacific women living in this country.”
Dr Lao’s Lupus/SLE Postdoctoral Fellowship produced a number of publications in internationally recognised research journals such as Lupus and Journal of Clinical Rheumatology. Going forward, the findings will provide a significant evidence base that can directly inform healthcare policy and practice.
