Epidemiological perspectives on SLE and APS in MENA: Burden,barriers,and a path toward improved outcomes

Abstract

Background: Systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS) are complex autoimmune diseases with the potential to affect multiple organ systems and significantly impact quality of life. In the Middle East and North Africa (MENA), the burden of these conditions is amplified by a combination of genetic predisposition, environmental exposures, and socio-economic factors that shape both presentation and outcomes. High consanguinity rates, high ultraviolet exposure, infections, and lifestyle factors contribute to earlier onset and more aggressive disease, with lupus nephritis affecting up to 60% of patients. APS adds an additional layer of complexity through thrombotic events and pregnancy complications. Purpose: This review brings together current knowledge on the epidemiology, clinical patterns, and management challenges of SLE and APS across the region. Results: While individual country reports exist, the lack of large-scale registries limits our ability to fully define disease prevalence and outcomes. Delayed diagnosis, shortages of rheumatology specialists, and unequal access to advanced diagnostics and biologic therapies remain persistent barriers. In some low-resource or conflict-affected settings, even basic immunosuppressive medications are inconsistently available. The financial impact is substantial, driven by hospitalizations, medications, and loss of productivity, with many patients facing significant out-of-pocket costs. Recent advances, including biologics such as belimumab and anifrolumab, offer opportunities to improve outcomes but are not equitably accessible across the region. Conclusions: Moving forward, investment in healthcare infrastructure, training, and culturally appropriate patient education will be essential. Establishing regional registries, expanding research into genetic and environmental risk factors, and developing locally relevant management strategies are critical next steps. By addressing these gaps through coordinated action between policymakers, healthcare providers, researchers, and patient communities, it is possible to reduce the disparities in care and improve survival, function, and quality of life for people living with SLE and APS in the MENA region.