Accelerated damage accrual among men with systemic lupus erythematosus: XLIV. Results from a multiethnic US cohort

Abstract

Objective. To determine the impact of the patient's sex on the manifestations and outcome of systemic lupus erythematosus (SLE).Methods. We studied SLE patients who were ages 16 years or older and had a disease duration of <5 years at the time of enrollment in the LUpus in MInorities, NAture versus nurture cohort, a multiethnic cohort consisting of Hispanic, African American, and Caucasian patients. Socioeconomic/demographic, clinical, and serologic features, as well as disease activity (by the Systemic Lupus Activity Measure, Revised) and damage accrual (by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index) were compared between male and female patient groups. Multivariable analyses using male sex and damage accrual as dependent variables were then performed.Results. Sixty-three male SLE patients (10.2%) from all ethnic groups were included. The mean ages of the male and female patients were comparable. Factors that were either more frequent or tended to be more frequent among male SLE patients were Caucasian ethnicity, smoking, alcohol use, lupus anticoagulant (LAC) positivity, and renal involvement, whereas musculoskeletal involvement was less common. American College of Rheumatology criteria accrual time and disease duration were shorter in the male patients; damage was more common and of higher magnitude in this group. LAC positivity, shorter disease duration, and higher early damage scores were independently associated with male SLE. Male sex was a strong predictor of baseline damage, measured as a categorical variable (t-test ‫؍‬ 2.357, ␤-standardized coefficient 0.113; P ‫؍‬ 0.019) or a continuous variable (hazard ratio 3.179 [95% confidence interval 1.999-5.056]; P < 0.001). Male sex was also positively associated with the development of damage over most of the course of the disease.Conclusion. Poorer long-term prognosis among men with SLE appears to be decisively determined by their accelerated development of damage, particularly early in the course of the disease.Systemic lupus erythematosus (SLE) is an autoimmune disease that occurs more frequently among women, predominantly during their childbearing years. Its wide range of clinical manifestations and its overall prognosis have been repeatedly differentiated by sex as well. Male SLE patients have been reported to develop more severe skin lesions (1-3), serositis (i.e., pericarditis and/or pleuritis) (2-5), renal involvement (5), thrombotic events (6), and seizures (7) as compared with

The TLR7 7926A>G polymorphism is associated with susceptibility to systemic lupus erythematosus

“…Findings of several studies have demonstrated that male SLE patients present a typical manifestation, tend to have a significantly worse prognosis and have more serious kidney involvement (41)(42)(43). More specifically, a recent study has addressed the gender-based differences in Brazilian lupus patients and demonstrated that male patients had more severe LN, as indicated by higher creatinine levels and by comparison of the histopathological activity index values when compared to females diagnosed with this renal abnormality (44).…”

Irreversible organ damages in patients with systemic lupus erythematosus. SLICC damage index

“…Andrade и соавт. [21] при изучении пациентов мужского и женского пола со средней продолжительностью СКВ, равной 58,9±44,2 (M±SD) и 63,7±42,6 мес соответственно, установили, что более раннее развитие повреждения ассоциировано с мужским полом, возрастом, этнической принадлежностью, употреблением алкоголя, активностью и аномальным поведением, связан-ным с болезнью. В другом исследовании при изучении муж-чин и женщин, больных СКВ, одного возраста, имевших сходные давность, течение заболевания и длительность на-блюдения, установлено, что сумма баллов ИП у мужчин бы-ла достоверно выше, чем у женщин [22].…”

“…Активность болезни и выраженность обострения во время проведения исследования также предшествовали нара-станию степени повреждения в гонконгской когорте [32]. Прямая связь между высокой активностью и развитием по-вреждений выявлена и в других исследованиях [21,41].…”

The Role of B-Cells and B-Cell Targeted Therapies in Lupus Nephritis

“…Two trials are 6. Possible future therapies 6.1 Abatacept Binding of CD28 on T cells to its ligand CD80/86 on APCs and activated B cells provides the major costimulatory activation signal to T cells. Endogenous CTLA-4 is an inhibitory molecule on previously activated T cells that binds CD80/86 with higher affinity than CD28.…”