Improving Lupus Care Requires Addressing Social Determinants, Expanding Access: Margrit Wiesendanger, MD, PhD

In the fourth and final part of the interview with Margrit Wiesendanger, MD, PhD, of Icahn School of Medicine at Mount Sinai, she highlights key changes needed to improve lupus care and outcome disparities, especially among Black and Hispanic patients.

Watch parts 1, 2, and 3 to learn more about the clinical presentation of lupus, the emerging treatment landscape, and disparities across patient populations.

Transcript

What changes are needed to meaningfully address disparities in lupus care?

I believe that in order to meaningfully address the disparities in care, we have to address the upstream social determinants of health. It's, again, all about access. Access to resources, be they financial, housing, or nutrition. Access to specialists who are able to diagnose and treat the condition, and access to a tailored pharmacotherapy regimen that exactly meets the needs of the patient.

Lupus is a very diverse disease itself. It probably should be thought of as more of an umbrella term that covers multiple related conditions. They have commonalities. The fundamental immunology that underlies systemic lupus is fairly consistent, as we're getting more knowledge about how B cells work and how they order T cells around. I mean, that's my feeling about the immunology of this. On the other hand, one size certainly does not fit all. Every patient with lupus has a unique need, and we really must keep that in mind, and there's no way to really broadly categorize the patients.

What we're trying to do at Mount Sinai is we would like to be able to improve that access for our patients. We merged the faculty and the fellow practices so that we could have a single ambulatory site that participates with every type of insurance, commercial or government insurance, and we also have a sliding scale for patients who are underinsured or uninsured. That was a big advance.

The second advance was that my colleague, Dr Dobrowolski [Chrisanna Dobrowolski, MD] founded a multidisciplinary lupus clinic with support from the American College of Rheumatology and collaboration with other departments outside of our own rheumatology division, which included psychiatry and nephrology. The clinic is housed at the Mount Sinai Morningside campus and aims to offer patients with lupus a multidisciplinary approach to their health.