Limited Management of Systemic Erythematosus Lupus in Madagascar

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that involves multiple organs and has alternating periods of flare-ups and quiescence. SLE requires multiple paraclinical and therapeutic investigations that are not accessible by Malagasy patients. We aim to assess the monthly direct cost in SLE referring to international recommendations. The cost of paraclinical exams and treatment expenses were estimated as a percentage of the MMMS (Malagasy Minimum Monthly Salary). According to international recommendations, the cost of first-line paraclinical exams for SLE diagnosis was 274,2% of the MMMS. The costs of diagnostic tests were 110,9% and 923,4% of the MMMS to research renal and neurological damage, respectively. The monthly cost of pharmacological therapies ranged from 132,2% to 205,9% of the MMMS, depending on the severity of SLE. Clinical examination and affordable paraclinical exams were fundamental in our practice to manage systemic lupus erythematosus lupus. Appropriate recommendations for emergent countries should be come up.