Clinical Phenotype and Complications of Systemic Lupus Erythematosus among Adults in Middle Eastern Populations: A Synthesis of Observational Cohorts (2021–2025)

Abstract

Systemic lupus erythematosus (SLE) exhibits profound clinico-geographic heterogeneity, yet contemporary data from Middle Eastern populations remain fragmented. This synthesis of 12 observational cohorts (2021–2025) from Middle Eastern countries delineates a regional phenotype characterized by high disease activity and significant organ-threatening manifestations. Across these cohorts, SLE presents as a predominantly moderate-to-severe multisystem disorder. While mucocutaneous and musculoskeletal involvement are ubiquitous – exceeding 75% in several Egyptian registries – the high prevalence of lupus nephritis and hematologic cytopenias in Omani, Syrian, and Palestinian populations underscores a substantial burden of severe disease. The regional data further reveal a pronounced thromboinflammatory profile, with frequent reports of vasculitis, pericarditis, and both arterial and venous thrombosis, suggesting accelerated premature atherosclerosis. Neuropsychiatric involvement, encompassing seizures and cerebrovascular events, contributes significantly to cumulative morbidity. Although methodological heterogeneity among tertiary-care cohorts precludes a formal meta-analysis, the consistency of these patterns indicates that Middle Eastern SLE patients experience a disease course at the more severe end of the global spectrum. These findings highlight a critical “window of opportunity” for early intervention following initial musculoskeletal or mucocutaneous presentations. To improve long-term outcomes and reduce premature mortality, there is an urgent need for systematic organ screening, aggressive management of high-risk features, and the establishment of harmonized, population-based registries across the region to bridge existing gaps in longitudinal care.