Lupus: Autoimmune disease that attacks more women than men

Think of a security system that suddenly views the home it guards as an intruder. For those living with systemic lupus erythematosus (SLE), this is not a hypothetical glitch; it is a biological reality.

Living with this chronic autoimmune condition means the body’s immune system misidentifies its own healthy tissues as foreign threats, triggering waves of inflammation that can devastate the kidneys, joints, lungs, brain and heart.

Lupus is notoriously difficult to track because patients experience it differently. Symptoms arrive in waves known as flares, followed by periods of remission, when the disease remains dormant, depending on the type of lupus affecting the individual.

However, the toll of the condition is cumulative. Over the years, these “assaults” by the immune system can lead to permanent organ damage, resulting in kidney failure, heart disease, sudden-onset seizures, or chronic complications such as photosensitivity and dry eye.

Despite decades of research, medical experts have yet to identify a single, definitive cause for lupus. Instead, they point to a combination of biological and environmental factors that can tip the body into a state of self-attack.

According to Dr George Oyoo, a rheumatologist at Nairobi Arthritis Clinic in Westlands, Nairobi, genetics play a central role, particularly factors linked to the X chromosome.

“Lupus may remain dormant in the body, and due to triggers such as extreme sunlight, a wave of chronic inflammation may occur,” says Dr Oyoo. “However, it is also possible for a patient to develop lupus with no family history of the disease.”

Sex hormone

Another biological factor, he explains, is the production of the sex hormone oestrogen. Both men and women produce oestrogen, but women generally produce higher levels, which may help to explain why women are disproportionately affected by lupus.

An article by Nancy Walsh published in 2018 on oestrogen and lupus echoes this view. It cites research by Dr Wael N. Jarjour, director of rheumatology and immunology at The Ohio State University College of Medicine, who explains why women are more commonly affected by the condition.

According to Dr Jarjour, the answer may lie within the X chromosome. Women carry two X chromosomes, which could increase susceptibility to the activation of certain genes housed on those chromosomes, triggering the immune system to misfire.

The impact of lupus is visible in Kenya. Dr Oyoo says he is currently treating around 500 patients aged between 20 and 40. Over years of practice, the most common clinical presentations he observes include joint pain, headaches, anaemia, hair loss and inflammatory arthritis.

As of 2026, Kenya has a population of approximately 58.6 million. Yet despite this sizeable population, the country has only 10 licensed rheumatologists, making early diagnosis and appropriate treatment difficult to access. In some cases, patients may be misdiagnosed with malaria, tuberculosis or HIV — illnesses that also present with fever — largely because awareness of lupus remains limited.

Public hospitals often lack the specialised laboratory equipment required for accurate testing. A comprehensive diagnostic test for lupus can cost around Sh20,000, while monthly medication expenses range between Sh20,000 and Sh50,000 or more.

To manage flare-ups, Dr Oyoo prescribes medications such as hydroxychloroquine, cyclophosphamide and belimumab, just to mention a few.

Financially draining

Interestingly, according to Dr Oyoo, the new medical scheme, Social Health Authority (SHA), does not currently cover treatment for lupus and other musculoskeletal diseases. As a result, patients must pay out of pocket, an immense burden for many who already contribute to national insurance schemes in the hope of financial protection.

Paris Nnlele, a resident of Kasarani, was diagnosed with lupus in 2024. She recounts how the disease altered the course of her life.

“When I was admitted, some of my relatives had to contribute because my insurance cover was exhausted. The total bill amounted to KSh3 million,” she says.

A segment aired on The Health Digest on Kenya Television Network in May 2025 reported that, in some cases, a patient with lupus may need to raise as much as Sh100,000 a month for immune-regulating medication, Sh350,000 to prevent flare-ups, and a further Sh70,000 for supportive therapies and additional MRI scans.

Diagnosis requires comprehensive evaluation by a rheumatologist, who are quite few in the country. This typically involves detailed blood tests, urinalysis and physical examinations to distinguish lupus from other inflammatory conditions.

Lupus is a lifelong condition that must be managed for the rest of one’s life. While there is no cure, doctors work with patients to find a combination of treatments that control symptoms and reduce inflammation. With the right regimen, some patients can achieve remission — periods during which the disease is largely inactive. But for many, the balance between flare and stability remains a delicate, lifelong negotiation.