Clinical and immunological characteristics of 56 patients with systemic lupus erythematosus in Uganda

Abstract

Objectives The prevalence and burden of SLE in Africa are poorly understood. This health-facility-based retrospective study aimed to describe the frequency and the clinical and immunological characteristics of SLE in Uganda. Methods We reviewed clinical notes of patients presenting with rheumatological complaints in two large rheumatology outpatient clinics in Uganda between January 2014 and December 2019. Results Of the 1019 charts reviewed, 5.5% (56) of the patients had confirmed SLE, with a median age of 29 (range: 14–65) years. The male-to-female ratio was ∼1:10, and 19.6% (11/56) of the patients had SLE and RA overlap syndrome. Patients presented with joint pains or swellings (n = 39, 69.6%), typical photosensitive malar rash (n = 34, 60.7%), oral ulceration (n = 23, 41.1%), anaemia (n = 14, 25.0%), hair loss and polyserositis (n = 12, 21.4% each), constitutional symptoms (n = 10, 17.9%), RP (n = 4, 7.1%) or LN (n = 3, 5.4%). ANA and anti-dsDNA autoantibodies were both positive in 25 (75.8%) of the 33 patients with available results. ANA titres were ≥1:160, with a median titre of 1:160 (range: 1:160 to 1:3200). Six patients had titres ≥1:320. The median dsDNA level was 80 (range: 40–283) IU. Ten patients had results of C3 and C4 complement protein levels and, of these, 4 patients had low C3 levels and 3 had low C4 levels. Conclusion SLE is uncommon among patients presenting with rheumatological complains in Uganda. SLE overlaps with RA in our setting, and a majority of patients present to care with complications.

Clinical and laboratory profile of systemic lupus erythematosus patients at a rural tertiary centre in South-South Nigeria: experience from a new rheumatology clinic

“…The most common manifestation was polyarthritis (86.5%), which is consistent with a previous study by Adelowo et al (87%) in Southwest Nigeria [14]. Similar findings were observed in Kenya (90%) [16], Uganda (69.9%) [23], Sudan (85.5%) [19], South Africa (90%) [18], Morocco (82%) [24], India (78%) [25], and Tunisia (87.1%) [26]. The cumulative frequencies of clinical and immunological profiles of SLE patients across Africa are represented in Table VI.…”

“…The use of oral contraceptives and postmenopausal hormones has been linked to the onset of SLE, implying that hormonal factors may play a role in its pathogenesis [ 21 ]. The average age at diagnosis is slightly lower, but it is similar to other African and Asian studies [ 16 , 22 , 23 ].…”

“…The incidence of renal disease in SLE varies depending on the population studied. Nephritis was found in 38.5% of our sample, and varying frequencies of 5.4% in Uganda [ 23 ], 24% in Kenya [ 16 ], and 49.5% in Tunisia [ 26 ] have been reported. Higher incidences of lupus nephritis have been reported in other African studies [ 13 , 19 , 32 ].…”

“…Most studies discovered comparable levels of ANA positivity, typically greater than 80% [ 14 , 16 , 24 , 27 ]. Ekwom in Kenya [ 32 ] and Bongomin et al in Uganda [ 23 ] reported prevalence rates of 76.9% and 75.8%, respectively. These high rates have also been reported in European studies [ 33 ].…”

Patient-Reported Outcomes of Ugandans Living with Autoimmune Rheumatic Diseases

“…There are no locally validated rheumatic disease specific PROMs in Africa and data on PROs of patients with rheumatic diseases in Africa is scanty, even though these diseases, especially RA and SLE are increasingly being reported in Africa. 7–9 This study aimed to describe PROs of patients with autoimmune rheumatic diseases in two tertiary care centers in Uganda.…”