Autoimmune diseases in Senegal: the case of systemic lupus in 2024
The problem of autoimmune diseases in Senegal
Senegal faces a double burden: communicable diseases, which are increasingly prevalent.
in better controlled areas, and non-communicable diseases (NCDs). The latter represent a high cost for patients, their families, and society. This is why Senegal has integrated them into the fight against disease and is striving to organize their management at the national level.
However, another group of diseases, autoimmune diseases, is not yet adequately managed. These diseases are linked to a disruption of the immune system. Among them, lupus erythematosus is one of the most common in Senegal. A hospital series published in 2014 reported 161 cases (Ref: RAFMI - 2014; 1(2): 1-44), a figure that is likely a significant underestimate.
Systemic lupus erythematosus (or disseminated lupus erythematosus)
What is systemic lupus erythematosus (SLE)?
Systemic lupus erythematosus (SLE), formerly known as disseminated lupus erythematosus, is a chronic disease. Its origin lies in an inflammatory process of the connective tissue. This disease belongs to a larger group of diseases called autoimmune diseases.
Each individual's immune system is designed to defend the body against bacteria, viruses, parasites, and other foreign substances. To do this, it produces substances called antibodies. In the case of an autoimmune disease, these antibodies, called autoantibodies, attack the body's own normal organs and other components. This causes specific inflammation, leading to dysfunctions that can affect the skin, joints, kidneys, heart, blood vessels, and nervous system.
These conditions can lead to major disabilities or even death. However, early diagnosis and prompt treatment can prevent this damage.
The extent of SLE in Senegal
The apparent rarity of lupus in Senegal is often due to difficulties and delays in its diagnosis. Several factors contribute to this situation:
The signs of the disease are often nonspecific. They are initially dismissed by the patient and can be confused with other illnesses, thus delaying diagnosis.
Many patients first consult traditional healers, especially in cases of skin lesions, due to ignorance of the disease.
The number of specialists in these conditions is still limited in our country.
Diagnosis requires immunological tests, the cost of which is often prohibitive for patients and their families. For example, to diagnose diabetes mellitus, a simple blood glucose test costs between 2,000 and 3,000 FCFA (3 to 4.50 €). In contrast, an antibody test can cost up to 45 € per test, multiplying the cost by 10 or 20. Until Universal Health Coverage (CMU) is fully operational, these costs are often borne by families.
Why are women more affected?
Lupus occurs in 9 out of 10 cases in adolescent girls or young adults. This is due to several factors, including genetic and hormonal factors, particularly estrogen. Although it is not strictly a hereditary disease, its genetic component means that several members of the same family can be affected.
The treatment of LES
With early treatment and regular follow-up, patients can lead a near-normal life in the long term. The primary treatment relies on anti-inflammatory medications, particularly corticosteroids. These medications, often prescribed for several years at high doses depending on the severity of the disease, can cause side effects. These include sleep and mood disturbances, hormonal imbalances, muscle or bone loss (osteoporosis), weight gain, and an increased risk of infections.
Immunosuppressants, powerful drugs designed to reduce inflammation and suppress harmful autoantibodies, are an alternative. However, they are much more expensive, costing up to €6 to €7 per day.
It is crucial never to interrupt these treatments without consulting a doctor. Furthermore, they require close monitoring with regular, often costly, specialist examinations. Patient involvement in this process is therefore essential. Therapeutic patient education (TPE) is a major asset for the effectiveness of treatments and the prevention of disease flare-ups and complications.
To conclude
We are paraphrasing the conclusion of a work published in 2014:
"The presence of lupus in Senegal is confirmed, with severe forms at diagnosis, which demonstrates the delay in its identification. Continuing education for practitioners, aimed at training more specialist physicians in the management of autoimmune diseases, could improve the prognosis. In addition, raising patient awareness of the possibility of single-organ involvement could reduce the diagnostic delay. It is essential to combat ignorance to enable earlier diagnosis." (Ref: RAFMI - 2014; 1(2): 1-44).
It is therefore urgent to make diagnosis, treatment, and follow-up accessible to everyone in our country. Patient education is essential.
Professor Saïd Norou DIOP, former Head of the Internal Medicine Department, Dakar
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