Clinical Characteristics of Patients with Systemic Lupus Erythematosus in Nairobi, Kenya

Abstract

Background: Systemic lupus erythematosus (SLE), a chronic multisystem autoimmune disease with a wide spectrum of manifestations, shows considerable variation across the globe, although there is data from Africa is limited. Quantifying the burden of SLE across Africa can help raise awareness and knowledge about the disease. It will also clarify the role of genetic, environmental and other causative factors in the natural history of the disease, and to understand its clinical and societal consequences in African set up.

Objective: To determine the clinical profile of SLE patients at a tertiary care centre in Nairobi, Kenya.

Methods: Case records of patients who were attending the Nairobi Arthritis Clinic seen between January 2002 and January 2013 were reviewed. This was a cross-sectional study done on 100 patients fulfilling the 2012 Systemic Lupus Collaborating Clinics (SLICC) criteria for SLE attending the Nairobi Arthritis Clinic, Kenya. The patients were evaluated for sociodemographic, clinical and immunological manifestations and drugs used to manage SLE.

Results: Hundred patients diagnosed with SLE were recruited into the study. Ninety seven per cent of the study participants were female with a mean age of 36.6 years. Thirty three years was the mean age of diagnosis. The mean time duration of disease was 3 years with a range of 0-13 years. There was extensive disease as many had multi-organ involvement. Majority (83%) of the study participants met between 4 and 6 manifestations for the diagnosis criteria for SLE. Non erosive arthritis and cutaneous disease were the commonest initial manifestation. The patients had varied cutaneous, haematological, pulmonary, cardiac, renal and neuropsychiatric manifestations. Antinuclear antibody (ANA) assay and anti-dsDNA was positive in 82% and 52%. Patients on steroids, non-steroidal drugs and synthetic disease modifying anti-rheumatic drugs were 84%, 49% and 43% respectively. None of the patients were on biologic disease modifying antirheumatic drugs.

Conclusions: In Nairobi, SLE is a multisystem disorder affecting predominantly young females. Polyarthritis and cutaneous disease were the most common clinical features. This is comparable to other studies done in black African population. We found a higher prevalence of haematological and lower rate of renal disease as compared to other studies done in black Africans. The ANA assay and anti-dsDNA positivity was lower than those in other studies on black Africans. Majority of the patients were on steroids.

Keywords: SLE, Nairobi, Kenya