Severe Organ Involvement in Systemic Lupus Erythematosus: A Retrospective Single-Center Study From Morocco

Introduction Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by multisystem inflammatory involvement and an unpredictable clinical course. SLE is among the most prevalent autoimmune diseases in Morocco, yet epidemiological and clinical data from this region remain limited. Disease management relies mainly on conventional therapies, with restricted access to advanced targeted treatments. Objective To describe the epidemiological, clinical, biological, and therapeutic characteristics of patients diagnosed with SLE in an internal medicine department in Morocco, with a particular focus on severe renal, hematological, and neurological manifestations. Methods We conducted a retrospective descriptive study including 61 patients diagnosed with SLE between January 2017 and September 2022 at the Internal Medicine Department of the International University Hospital Cheikh Khalifa Ibn Zaid in Casablanca, Morocco. Diagnosis was established according to the 2019 European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) and/or the 2012 Systemic Lupus International Collaborating Clinics (SLICC) classification criteria. Data were collected from medical records and analyzed using descriptive statistical methods. Results The study population was predominantly female (n=55; 90.2%), with a mean age at diagnosis of 40.3 years (SD 14.2; median 40; range 13-74). The most common manifestations were fatigue (82.0%), arthralgia (70.5%), and malar rash (59.0%). Hematological involvement was prominent: anemia was present in 29 patients (47.5%), of whom 10 (16.4%) had confirmed autoimmune hemolytic anemia (AIHA). Renal involvement was identified in 10 patients (16.4%); among the seven who underwent biopsy, class IV lupus nephritis predominated (n=5; 71.4%). Neurological involvement was documented in 14 patients (22.5%), with the majority comprising nonfocal manifestations such as persistent headaches and mood disorders. Most patients were treated with hydroxychloroquine (n=48; 78.7%) and systemic corticosteroids (n=38; 62.3%); immunomodulatory therapy was required in 18 patients (29.5%). Of the 39 patients with complete follow-up (median 28 months), 14 (35.9%) achieved complete remission, 19 (48.7%) achieved partial remission, 13 (33.3%) experienced disease relapse, and six (15.4%) achieved neither. Conclusion This single-center Moroccan cohort highlights a substantial burden of hematological involvement and reveals a treatment landscape defined by restricted access to biologic therapies. The findings underscore the need for region-specific epidemiological data, improved access to targeted treatments, and dedicated prospective research to better characterize SLE in North African populations.