Background This systematic review of literature and meta-analysis aimed to determine the prevalence, phenotype and treatment of systemic lupus erythematosus (SLE) in Native sub-Saharan Africans.

Methods PubMed, EMBASE, Web of Science, African Journals Online, and Global Index Medicus as well as references of retrieved papers were searched to select studies addressing SLE in Native sub-Saharan Africans and published during January 1, 2008- October 7, 2018. Results were pooled through narrative review and random-effects model. Heterogeneity (I²) was assessed via the χ² test. Pooled estimates are expressed with 95% confidence intervals. This study is registered with PROSPERO: registration number CRD42019139226.

Results Fifteen hospital-based studies were included out of 1502 records. The pooled prevalence of SLE was 1.7% (0.8–2.9). The mean age at diagnosis ranged from 28.8 to 39.2 years. The female proportion was 88%-100%. Rheumatological (5.1%-99.9%), dermatological (4.3%-100%) and hematological (1.4–86.9%) manifestations were the commonest. Patients had a high seroprevalence for anti-ribonucleoprotein 57.9% (36.4–77.9), anti-Smith 53.5% (40.4–66.2), anti-Sjogren syndrome antigen A 45.6% (19.2–73.4) and anti-Sjogren syndrome antigen B 33.7% (13.6–57.6) autoantibodies. The most used treatments were corticosteroids 99% (94.9–100) and antimalarials 62. 8% (23.3–94.1). The pooled mortality rate was 10.3% (3.3–20.6); mainly due to infections, kidney and neurological involvement.

Conclusions Over the last 30 years, SLE was not rare among Native sub-Saharan Africans and its featured characteristics were earlier onset, female predominance, and high seropositivity for extractable nuclear antigen autoantibodies. The standard treatments were corticosteroids and antimalarials. The mortality rate was high. Population prevalence and incidence as well as full description of SLE characteristics in Native sub-Saharan Africans are needed.