Lupus in Senegal: Seven Years of Data Reveal a Hidden Burden in Rural West Africa

Systemic lupus erythematosus has long been described as a disease of young women, but reliable data from rural sub-Saharan Africa remain scarce. A new retrospective study from the Abdou Aziz Sy Dabakh Hospital in Tivaouane, Senegal, now offers one of the most detailed pictures yet of how lupus presents in a decentralized setting far from the continent’s major referral centers. Drawing on seven years of records from 2017 to 2024, the research team identified 84 patients diagnosed according to the ACR/EULAR 2019 and ACR 1997 classification criteria, yielding a prevalence of 0.15 percent among roughly 56,000 patients followed at the hospital during the study period.

The demographic profile confirms patterns familiar from other African series but adds important nuance. The mean age at diagnosis was 36.67 years, with patients ranging from 11 to 70 years old, and the 10-to-30 age group accounted for 41.6 percent of cases. Women dominated overwhelmingly: 77 of the 84 patients were female, producing a sex ratio of 0.09, meaning roughly eleven women for every man. Most patients were married (61.9 percent), worked in the primary sector (88 percent), and came from urban areas (73.8 percent), although a meaningful minority lived in rural or semi-urban surroundings. Half of the patients had experienced symptoms for less than a year before entering the cohort, while 45 percent had lived with the disease for one to five years.

Clinically, the disease showed its characteristic protean face. Joint involvement was the most frequent category, affecting 64.28 percent of patients, followed by mucocutaneous signs at 54.76 percent and general symptoms at 52.38 percent. Within these categories, inflammatory polyarthralgia stood out as the single most common finding, present in 63.1 percent of patients, while physical asthenia affected 47.6 percent. Skin manifestations included erythematosquamous lesions in 16.7 percent of patients and non-specific erythematous lesions in 15.5 percent, with discoid lupus, malar (vespertilio) erythema, alopecia, and Raynaud’s phenomenon each appearing in smaller proportions. Neuromuscular signs affected 20.24 percent of patients, cardiovascular signs 15.48 percent, pleuropulmonary signs 13.10 percent, and digestive signs 7.14 percent.

The laboratory findings underscore both the diagnostic value and the limitations of routine testing in resource-constrained settings. Anemia was the most common hematological abnormality, found in 66.1 percent of patients, followed by elevated C-reactive protein in 36.9 percent and an accelerated erythrocyte sedimentation rate in 20.2 percent. Antinuclear antibodies, measured by indirect immunofluorescence on HEp-2 cells, were positive in 71.4 percent of patients, with titers ranging from 80 to 10,000 IU and a mean of roughly 1,007 IU. The speckled fluorescence pattern predominated at 85.9 percent, far ahead of homogeneous, nucleolar, centromeric, and cytoplasmic patterns. Anti-dsDNA antibodies were detected in 12 percent, anti-Sm in 10.7 percent, and a broad panel of anti-ENA specificities, including anti-Ro52 at 11.9 percent, completed the immunological picture. Skin biopsies revealing the characteristic lupus band were performed in 21 of 22 patients referred from dermatology, supporting the diagnosis in a quarter of the cohort.

Disease activity, quantified with the SLEDAI-2K score, averaged 5.74 on a scale from 0 to 19. Just over half the patients (51.19 percent) had mild activity, 22.62 percent had moderate activity, and 26.19 percent had severe disease. Severe systemic complications were led by cardiac involvement in 9.5 percent of patients, renal involvement in 7.1 percent, and neurological involvement in 5.9 percent. Cardiac events included intracardiac thrombosis, thrombophlebitis, heart failure, and pericarditis, while renal manifestations ranged from isolated proteinuria to renal insufficiency requiring ongoing nephrology care after a biopsy confirmed diffuse stage IV glomerulonephritis in one patient. Neurological presentations included altered mental status, psychosis, and coma.

The study also documented the overlap phenomenon that complicates lupus diagnosis worldwide. Six patients carried a concurrent diagnosis of rheumatoid arthritis, the most frequent association in the cohort, followed by two patients each with antiphospholipid syndrome, multiple autoimmune syndrome, and systemic scleroderma. Single cases of Sjögren’s disease and combined scleroderma-rheumatoid arthritis were also recorded. Two patients had childhood-onset lupus, aged 11 and 15, both presenting with distinct dermatological manifestations including malar erythema and characteristic histopathological features. Notably, the authors observed that lupus beginning at an older age tended to present with greater disease severity and more cardiopulmonary complications.

Treatment reflected the realities of a regional hospital working with limited resources. Hydroxychloroquine, the immunomodulator that forms the backbone of lupus therapy worldwide, was prescribed to 88 percent of patients, while azathioprine was used in 7.14 percent. A small number of patients received additional agents, including corticosteroid boluses, oral anticoagulants, and supportive medications. The authors note that hydroxychloroquine reduces the risk of disease flares, allows lower corticosteroid doses, and helps prevent lupus-related thromboembolic disease, and that it is not contraindicated during pregnancy. Access to newer biologic therapies, such as anti-interferon agents and monoclonal antibodies like belimumab and rituximab, remains limited in Africa, where high cost restricts widespread use.

Statistical analysis revealed a striking observation: all cases of cardiac complications occurred in female patients, although the association between sex and cardiac involvement did not reach statistical significance (OR 2.59, 95 percent CI 0.13 to 49.5, p = 0.59). The authors attribute the wide confidence interval to the small number of events and the marked imbalance between sexes. Disease severity, by contrast, appeared more closely linked to delayed diagnosis and was more commonly observed in women, though this too fell short of statistical significance (p = 0.18).

The findings align closely with other West and Central African studies. The prevalence of 0.15 percent sits below the 0.27 percent reported by Daou and colleagues across three hospitals in Niamey, Niger, and well below the 2.19 percent reported by Camara and colleagues over five years in Abidjan, a difference the authors attribute to their larger overall study population. The mean age of 36.67 years is consistent with the 33.9 years reported by Fall and colleagues in Dakar in 2011 and the 35 years found by Camara in Abidjan. The predominance of joint and skin symptoms mirrors patterns documented in Mali by Gassama and colleagues and in Cameroon by Bija and Eloundou and their teams, where polyarthritis and cutaneous signs consistently top the list of presenting features.

The study’s limitations are candidly acknowledged. Its retrospective design, the lack of digitized medical records, and incomplete documentation mean some information may have been inaccurately captured. The resource constraints of the setting also meant that patients could not always afford the full range of tests or medications their conditions required. Yet the authors argue that these very constraints make the findings more valuable, because they document lupus as it actually presents in decentralized African healthcare rather than in specialized referral centers. Their conclusion is a call to action: lupus remains a multifaceted condition that is too often misdiagnosed, confused with endemic tropical diseases whose symptoms overlap with its own, and they recommend ongoing training for healthcare personnel alongside therapeutic education sessions for patients to close the diagnostic gap.

Subject of Research: Epidemiology and clinical presentation of systemic lupus erythematosus in a decentralized hospital setting in Senegal

Article Title: Epidemiological and diagnostic characteristics of systemic lupus erythematosus in a decentralized setting in sub-Saharan Africa

Article References: Diallo, B. M., Bacourine, S., Dione, H., Sow, A., Berthe, A., Toure, P. S., Diop, M. M., & Ka, M. M. (2026). Epidemiological and diagnostic characteristics of systemic lupus erythematosus in a decentralized setting in sub-Saharan Africa. Frontiers in Lupus, 4, Article 1924447. https://doi.org/10.3389/flupu.2026.1924447

Image Credits: AI Generated

DOI: 10.3389/flupu.2026.1924447

Keywords: systemic lupus erythematosus, Senegal, sub-Saharan Africa, autoimmune disease, epidemiology, SLEDAI-2K, hydroxychloroquine, antinuclear antibodies, diagnostic delay, rheumatology, Tivaouane, lupus nephritis