Lupus in Africans: Causes, Symptoms, Diagnosis and Treatment

By Chinedu Akpa. B. Pharm. Freelance Health Writer. Medically reviewed by: A. Odutola, MB.BS. PhD.

 

A black lady with systemic lupus erythromatosus showing dark hyperpigmented butterfly-like rash on her face. Image credit: Usatine RP.

 

 

Highlights

• Lupus is a chronic autoimmune disease that affects many parts of the body.
• An autoimmune disease is a condition in which the body attacks its own healthy organs, tissues and cells for unknown reasons.
• Symptoms of lupus vary according to the severity of the disease.
• The true number of people with the disease on the African continent is unknown due to various factors.
• Women are more affected by the disease than men.
• Gene and the environment play a big role in the disease condition. 
• Lupus cannot be cured but can be managed using medications and lifestyle modifications. 

 

Introduction

Your immune system is a very complex system within organs, cells and proteins in your body. 

But, did you know how essential your immune system is to your health? 

Did you know that your immune system protects you from falling ill as it recognises and fights every foreign invader (like germs, cancer cells, foreign proteins, etc.) that enters your body to harm it? 

Without your immune system, minor wounds can become very serious and life threatening as your body is unable to fight off infections and other foreign particles.

Strangely, your immune system can also turn around to harm you. 

How? 

Here is the answer: for reasons that are presently unknown, your immune system can falsely identify some parts of your body as foreign and harmful, thereby launching attacks to neutralise them. 

When this happens, your immune system is said to be hyperactive. This is what occurs with Systemic Lupus or Lupus for short. In this disease, your immune system can attack, damage and harm many organs, tissues and cells of your body simultaneously (See figure 1).

Figure 1: Showing organs damaged in Systemic Lupus Erythematosus. Click on image to enlarge. AI generated from Chatgpt

 

In this article, you will learn what Lupus is, its causes, risk factors, symptoms, diagnosis, complications, treatment and prevention. You’ll also learn about the challenges that people with Lupus in Africa face with diagnosis and treatment of the condition.

But before diving deep, consider the real life story of an African lady with Systemic Lupus to appreciate the issues underlying this condition in Africans.

Amahle’s story

Amahle (not her real name) was a 32-year-old married woman, teacher and resident of Polokwane, Limpopo, South Africa at the time of her diagnosis with Lupus, sometime in 1974. Her initial complaints were frequent episodes of generalised weakness, fever on and off, skin rashes, joint and muscle aches, unstable weight, and recurrent miscarriages. She had seen different general practitioners over the course of four years of her complaints during which she was treated variously for recurrent malignant malaria and arthritis. It took a referral to a specialist at then King Edward VIII hospital, now Victoria Mxenge Hospital in Durban, a tertiary public hospital and the main teaching hospital for the University of KwaZulu-Natal's Nelson Mandela Medical School, for the diagnosis of SLE to be made. She was put on appropriate treatment. Amahle eventually had a successful pregnancy and delivered her only child at age 38 years. She lived a fairly healthy life on treatment, but was hospitalised several times as she developed hypertension, chronic anaemia and other complications of SLE. She died at age 65 years from multiple organ failure including heart and end stage kidney disease. 

 

What is Lupus? 

Lupus also often referred to as Systemic Lupus Erythematosus (SLE) is a long-term illness where the body’s immune system attacks its own tissues. It can affect many parts of the body and cause a wide range of symptoms—from mild skin rashes to serious damage to organs.

Your immune system is designed to protect you from harmful germs (bacteria, viruses, fungi) and other invaders. However, sometimes, it gets confused and attacks healthy cells and tissues in your body.

When the immune system turns against itself it can create harmful substances called autoantibodies; this is how autoimmune diseases such as lupus are formed. Lupus can affect multiple organs in the body including the brain, spinal cord and peripheral nerves too. [1]

 

How Common is Lupus in Africa? 

Lupus affects people differently around the world because of factors like where they live, their age, gender, income, race or ethnicity, and level of education, as well as the environment they’re exposed to. [2] 

It is the most common whole body autoimmune disease. 

Although we don’t know exactly how common Lupus is in the general population of Sub-Saharan Africa, a hospital-based study from 1987 to 2014 suggested that about 2 out of every 100 people in the region may have the disease. [3]

The occurrence of Lupus is likely to be far less in the general population, so this report may not be sufficient enough to be used as a benchmark to estimate the widespread nature of the disease in Sub-Saharan Africa until a population-wise study is completed. [3]

 

Who Gets Lupus? 

• Women > Men
• Children
• Elderly
• Blacks > other racial groups

Lupus is most common among women of childbearing age. [4] They are nine times more likely to have the disease than men. Although, this risk tends to reduce during menopause; even then, they have twice the chance of having Lupus at this stage than men. [1] It has also been reported that Lupus can affect children and the elderly. The report also indicated that it is usually more severe in children than in adults.  [1]

Black people who live outside Sub-Saharan Africa, like those in the U.S., Europe, and the West Indies, are more likely to have Lupus. In fact, a study showed they are five times more likely to be diagnosed with the disease and get it twice as often as white people. Not only that, the Lupus they experience is usually more severe than what’s seen in other racial groups. [4]

Even though Lupus seems to be rare in Sub-Saharan Africa, [5] this might not be the full picture. The reason is that there aren’t enough specialists, many cases go undiagnosed, and a lot of people are unaware of the disease symptoms and don’t have easy access to proper healthcare. [6]

 

What are the Different Types of Lupus? 

Four different types of Lupus are recognised:

• Systemic Lupus (SLE): This is the most common form of lupus, accounting for more than 70% of all cases. It can affect all body parts, including skin, joints, heart, lungs, kidneys, liver, brain, or blood.

• Drug-Induced Lupus: This is caused by taking certain types of medicines, and it typically goes away when the patient stops taking the medication. Symptoms can be similar to systemic lupus.

• Cutaneous (Discoid): This is when lupus affects only the skin, typically in the form of rashes. It accounts for about 10% of all lupus cases.

• Neonatal Lupus: This is rare. It occurs when the mother’s antibodies affect the fetus. It can cause the baby to experience symptoms that range from a temporary rash to a permanent heart defect.

 

What Causes Lupus?  

Like many autoimmune diseases the cause of Lupus is still unknown but there are some risk factors that have been identified as triggers in high risk individuals. The two leading risk factors are environmental and genetic factors. [7]

Role of Environmental Factors 

Over the years, experts have paid more attention to how the environment can raise the risk of lupus. This is because some Africans who didn’t have lupus, developed the disease after moving to places like Europe or America. [6] This has prompted observational studies of the link between environmental factors and Lupus. Findings from such studies include: [7]

• Silica and silicates: The link between the exposure to silica and risk of Lupus has been established and observed in occupational and residential settings which includes urban and rural areas. Studies suggest that silica can cause the release of chemicals that can cause inflammation, cause cell damage from free radicals, and reduce the number of immune cells that regulate and maintain the balance of immune activities thereby preventing autoimmune diseases while silicates like asbestos have been associated with autoimmune causing cells called antinuclear antibodies. 

• Cigarette smoke: Components of cigarette smoke like tar, nicotine, carbon monoxide, and some organic compounds like benzopyrene can induce oxidative stress and cause a mutation in the DNA which can trigger lupus.

• Environmental contaminants: These (for example, phthalates) can be found in the day-to-day substances that are routinely used for various purposes. These substances include:
  • Dry cleaning solvents
  • Nail polish removers
  • Pain
  • Perfumes
  • Pesticides

Some of these substances have been found to alter the balance of sex hormones in the body and also cause oxidative stress which can increase the risk of Lupus. Exposure to pesticides whether for agricultural or residential use have been linked to Lupus risk as well. 

• Sunlight (UV light): Ultraviolet light can cause people who already have Lupus to flare up because of photosensitivity. 

• Vaccination: This has been proposed to be a potential trigger for the onset of Lupus because of its ability to stimulate the immune cells. However, this association is yet to be confirmed and more studies are required. 

• Infections: This could be a factor to influence the onset of Lupus. When you are infected by a disease early in life, your immune system may become primed in response to a reinfection later in life which can increase susceptibility to Lupus.

• External hormones: Hormones such as estrogen, progesterone, prolactin, and testosterone have great influence on how the immune system works. Oral contraceptives and hormone replacement therapy have been linked to an increase in the risk of Lupus.

Role of Alcohol

Alcohol is a staple in most homes and social gatherings but what is its relationship with Lupus? 

Recent studies have found that moderate intake of alcohol (approximately ½ drink per day) can reduce the risk of lupus. [8] This is due to the ability of alcohol to reduce the circulating amount of a substance that is thought to be implicated in autoimmune diseases called Stem cell factor. [8] However, people with lupus are advised to avoid alcohol because it can increase autoimmune flare ups, and the risk of liver damage, especially when taken with certain lupus medications. [9] Seek the advice of your healthcare provider on whether to take a drink or not, if you have Lupus. 

Role of Genetics

Genes are a very strong factor in shaping how we behave and how we look, though the environment has an influence too. Additionally, they also impact how certain disease conditions affect us. Sometimes when the obvious cause of a disease isn't present, the culprit might just be a gene that has been passed down from our parents or grandparents. And so, Lupus is one of the many diseases that could be gotten through gene transfer. [10]

About 7% of people with Lupus have a close family member like a parent or sibling, who also has the disease. If you have a family member with lupus, your chances of getting it too can be as high as 10% if you’re a female relative. [11] Therefore a family history of autoimmune diseases increases the risk of developing Lupus, and this risk rises as more relatives are affected. [11]

 

What are the Symptoms of Lupus? 

Lupus is commonly referred to as “the disease of countless manifestations“ because it can affect multiple organs in the body and present with varying symptoms, which can be mild or life-threatening. Its inflammatory process often involves the kidney, skin, lungs, brain, and heart. 

The common symptoms of Lupus can be grouped as follows:

Common symptoms of Lupus. Click on image to enlarge.

 

General Symptoms

• General body weakness
• Fever
• Unexplained loss of weight or weight gain

 

Organs and Systems Related Symptoms

Skin and hair symptoms

• Photosensitivity
• Butterfly rash
• Mouth or nose ulcers
• Hair loss

Joint and Muscle Symptoms

• Joint pain, swelling, and stiffness

Kidney Symptoms

• Foamy or bloody urine
• High blood pressure
• Swellings in the legs, around the eye, and feet

Heart and Lung Symptoms

• Chest pain
• Shortness of breath

Neurological Symptoms

• Headache
• Memory loss or confusion
• Seizures
• Psychiatric dysfunctions (anxiety, depression, psychosis)

Blood and immune system

• Frequent infection
• Blood clotting issues
• Anaemia

 

Complications of Lupus

As Lupus affects multiple organs in the body, it can also cause wide-ranging consequences or complications that include the following: [1]
 

Complications of Systemic Lupus. Click on image to enlarge. Credit: Adapted from Fanouriakis A. et al.

 

A. Organs/Systems Complications

• Kidney damage (lupus nephritis)

• Cardiovascular disorders (Hypertension, Myocarditis or inflammation of the heart muscles, and Pericarditis or inflammation of the lining around the heart) 

• Brain and Nerve disorders (Headache, Seizures, Memory loss, Demyelination disorders, Peripheral neuropathies, Psychiatric dysfunctions like anxiety, depression and psychosis)

• Pleuritis or inflammation of the tissue lining the lungs and inner chest wall

• Blood and blood vessel disorders (including anaemia, and other blood component disorders, clotting disorders, and vasculitis)

• Multiple joint pains, swelling and arthritis
   

B. Others

• Skin disorders (butterfly and other types of cutaneous rashes)

• Alopecia (Hair loss)

• Pregnancy complications (Miscarriages, Preeclampsia, Neonatal lupus)

• Gastrointestinal issues (Nausea, Vomiting, and Abdominal pains)

• More disease severity and higher death rates (in blacks compared to other racial groups)

 

How is Lupus Diagnosed? 

The diagnosis of lupus can be difficult because of the numerous organs of the body that are involved. Additionally, lupus symptoms can mimic and overlap with other conditions such as:

• Malaria
• Rheumatoid arthritis
• Scleroderma
• Thyroid disorders
• Multiple sclerosis
• Vasculitis 
• Polymyositis

Your doctor would have to exclude these disease conditions before confirming a diagnosis of Lupus. 

Ideally, your doctor would typically obtain your detailed medical history, perform a full and comprehensive physical examination and order several laboratory tests before confirming a diagnosis of Lupus. 

There is no one specific laboratory test that can diagnose this condition. The following are some of the tests that your doctor may order:  

• Complete blood count
• Kidney and liver test
• Urine test
• Lupus autoantibody
• Complement protein test

 

How is Lupus Treated?

There is no cure for lupus just as in many autoimmune diseases. The goal of treatment is to bring about remission or to slow down disease activities. 

The management of Lupus is often dependent on disease severity and manifestations. Oftentimes Lupus is usually mild when it manifests in areas of the body such as the skin, joints, muscles, and bones, and can often be managed with: [12]

• Non-steroidal anti-inflammatory drugs (NSAIDs:  To manage pain and inflammation. 
• Low-dose immunosuppressants: To suppress immune hyperactivity. 
• Short-course corticosteroids: For flares and reduction of inflammation. 

Generally, there are three categories of medications used in people with Lupus, they are: 

• Hydroxychloroquine (HCQ): This is a drug which is used traditionally as an antimalarial but later found to be useful in treating lupus. According to the European League Against Rheumatism (EULAR) it is the cornerstone of lupus treatment and everyone who has lupus should be recommended to take HCQ. [12]This is because it reduces the risk of disease flares by 20-40%, it reduces the risk of accrued organ damage, and also reduces the risk of progressive organ damage. [12]

• Corticosteroids: Because inflammation of different organs and systems of the body is common in Lupus, corticosteroid use is usually recommended by your doctor.

• Biologic agents: Act as targeted immunosuppresants. Unlike many lupus medications that suppress the entire immune system, biologic agents target specific parts of the immune system to reduce inflammation and slow disease progression in lupus patients. A more targeted treatment can result in lower side effects which could be one of the benefits of using biologics. Examples are:
  • Belimumab
  • Rituximab
  • Anifrolumab 

• Anticoagulants (Blood Thinners): As people with systemic lupus are prone to blood clots, these drugs are prescribed to prevent strokes and heart attacks..

Additional Therapies in the Treatment of Lupus

Adjuvant therapies in lupus are used to support the main medication to reduce the frequency of flares and severity of symptoms, and complications. They include:

1. Anti-inflammatory and Pain management

1. Nonsteroidal anti-inflammatory drugs (NSAIDs): Diclofenac, Ibuprofen, Naproxen
2. Acetaminophen: For mild pain when NSAIDs are not desirable. 

2. Bone and Joint Protection

1. Vitamin D and Calcium- Prevents osteoporosis caused by steroids, and reduces complications caused by vitamin D deficiency. 
2. Bisphosphonate (e.g., alendronate): Strengthens bones if at risk of osteoporosis induced steroids. 

3. Skin Protection

1. Sunscreen: To prevent sun-induced flares.
2. Topical steroids- To help with skin rashes.

4. Infection Prevention

1. Antibiotics prophylaxis: Because of suppressed immune from drugs, infection by microorganisms can become a recurring thing
2. Vaccination: Reduces infection since lupus medication can weaken the immunity. 

5. Cardiovascular Protection

1. Aspirin- Low dose aspirin can help prevent clots in lupus patients with antiphospholipid syndrome.

6. Lifestyle and Dietary Support

1. Smoking cessation: Helps to reduce flares and disease complications. 
2. Exercise and Physical Therapy: This helps to strengthen joint movement and reduces fatigue. 
3. Anti-inflammatory Rich Diet: Omega-3s, fruits, and vegetables help reduce symptoms through decrease of flare-ups. 

 

Is Lupus Preventable?

While Lupus cannot be currently prevented, there are things that you can do to help manage the disease, reduce flare-ups and complications. These include lifestyle modifications, use of medications, early detection, and the management of reproductive health issues. 

A. Lifestyle Modifications

Some lifestyle modifications you can undertake to manage the disease include:

• Sun Protection: As ultraviolet (UV) light triggers lupus flare-ups, it is important to use sunscreens to protect your skin when outdoors. It is also important to wear protective clothing and stay out of direct sunlight as much as possible.

• Exercise: Undertaking regular exercise promotes overall wellbeing, as well as helps to improve bone and heart health. 

• Eat healthy diet: A balanced diet that is high in fibre, rich in fruits, vegetables, and whole grains is highly advised.

• Avoid smoking: Smoking has many consequences that are bad for your health generally and worsen the effects of lupus on your lungs, heart and blood vessels.

• Stress Management: The use of mindfulness and other relaxation techniques help to lower flare-up risks in Lupus.

• Regular Medical Check-ups: Your healthcare providers are able to monitor your condition, identify problems early and provide early interventions when you keep to your scheduled and regular medical appointments.

B. Medication Use

It is important that you use your Lupus medications (see above) as advised by your healthcare providers. These are meant to help you manage mild to severe Lupus symptoms thereby reducing flare-ups and improving your wellbeing.

C. Early Detection

As autoimmune antibodies and inflammation may be present in your body long before the symptoms of Lupus appear, it is most important that you’re aware of your risk factors for Lupus. In doing so, you should discuss your odds of having Lupus early with your healthcare provider. This could prompt your evaluation, early diagnosis and intervention.

D. Reproductive Issues

As pregnancy is markedly affected in Lupus, it is very important to receive counseling from your healthcare providers regarding family planning and contraception. 

When you get pregnant it is important to advise your obstetrician early in order to get the close monitoring that you need for a successful pregnancy.

 

Conclusion

Lupus is a complex and challenging autoimmune disease that disproportionately affects women, particularly those of African descent. While its exact cause remains unknown, a combination of genetic predisposition and environmental triggers plays a significant role in its development. Due to limitations in diagnosis and healthcare access, the true prevalence of lupus in Africa remains uncertain.

The symptoms and complications of Lupus are as diverse and varied in severity as the multiple organs and systems that a affected.  Early diagnosis and appropriate treatment are crucial in preventing severe complications.

Although lupus has no cure, it can be effectively managed with medications, lifestyle modifications, and supportive therapies to improve quality of life. 

Increased awareness, research, and improved access to specialised healthcare services are needed in addressing the burden of Lupus in African populations.

 

References:

1. Justiz Vaillant AA, Goyal A, Varacallo MA. Systemic Lupus Erythematosus. [Updated 2023 Aug 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. [Cited June 15, 2025] Available from here.

2. Feldman CH, Hiraki LT, Liu J, Fischer MA, Solomon DH, Alarcón GS, Winkelmayer WC, Costenbader KH. Epidemiology and Sociodemographics of Systemic Lupus Erythematosus and Lupus Nephritis among US adults with Medicaid coverage, 2000-2004. Arthritis Rheum. 2013 Mar;65(3):753-63. doi: 10.1002/art.37795. Available from here.

3. Vento S, Cainelli F. Commentary: Systemic Lupus Erythematosus in Native Sub-Saharan Africans: A Systematic Review and Meta-Analysis. Front Med (Lausanne). 2020 May 27;7:202. doi: 10.3389/fmed.2020.00202. Available from here.

4. Essouma, M., Nkeck, J. R., Endomba, F. T., Bigna, J. J., Singwe-Ngandeu, M., & Hachulla, E. Systemic lupus erythematosus in Native sub-Saharan Africans: A systematic review and meta-analysis. Journal of Autoimmunity, 2020;102348. Available from here_. 

5. Gilkeson G, James J, Kamen D, Knackstedt T, Maggi D, Meyer A, Ruth N. The United States to Africa lupus prevalence gradient revisited. Lupus. 2011 Oct;20(10):1095-103. doi: 10.1177/0961203311404915. Available from here.

6. Paruk F, Dey D, Mosam A, Amira Christina O, Tikly M. Challenges in Diagnosis and Management of SLE in Africa: An Online Survey. ACR Open Rheumatol. 2025 Jan;7(1):e11749. doi: 10.1002/acr2.11749. Available from here.

7. Parks CG, de Souza Espindola Santos A, Barbhaiya M, Costenbader KH. Understanding the role of environmental factors in the development of systemic lupus erythematosus. Best Pract Res Clin Rheumatol. 2017 Jun;31(3):306-320. doi: 10.1016/j.berh.2017.09.005. Available from here.

8. Hahn J, Leatherwood C, Malspeis S, et al. Associations between daily alcohol consumption and systemic lupus erythematosus-related cytokines and chemokines among US female nurses without SLE. Lupus. 2020;29(8):976-982. doi:10.1177/0961203320929427. Available from here.

9. Lupus Foundation of America. Thinking about Drinking? Read this first. [Internet, n.d]. Cited June 15, 2025. Available from here.

10. Lupus Foundation of America. Is Lupus Genetic? [Internet]. October 20, 2022. Cited June 16, 2025. Available from here.

11.Sestan M, Kifer N, Arsov T, Cook M, Ellyard J, Vinuesa CG, Jelusic M. The Role of Genetic Risk Factors in Pathogenesis of Childhood-Onset Systemic Lupus Erythematosus. Curr Issues Mol Biol. 2023 Jul 17;45(7):5981-6002. doi: 10.3390/cimb45070378. Available from here.

12. Medscape. Systemic Lupus Erythematosus (SLE) Treatment and Management. [Internet]. Updated August 21, 2024. Cited February 16, 2025. Available from here

 

Related: Healthy African Foods for People with Autoimmune Disorders

 

 

Published: 18, 2024

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