Differences between Male and Female Systemic Lupus Erythematosus in a Multiethnic Population

Abstract

Objective Male patients with systemic lupus erythematosus (SLE) are thought to be similar to female patients with SLE, but key clinical characteristics may differ. Comparisons were made between male and female patients with SLE in the Hopkins Lupus Cohort. Methods A total of 1979 patients in the Hopkins Lupus Cohort were included in the analysis. Results The cohort consisted of 157 men (66.2% white, 33.8% African American) and 1822 women (59.8% white, 40.2% African American). The mean followup was 6.02 years (range 0–23.73). Men were more likely than women to have disability, hypertension, thrombosis, and renal, hematological, and serological manifestations. Men were more likely to be diagnosed at an older age and to have a lower education level. Women were more likely to have malar rash, photosensitivity, oral ulcers, alopecia, Raynaud’s phenomenon, or arthralgia. Men were more likely than women to have experienced end organ damage including neuropsychiatric, renal, cardiovascular, peripheral vascular disease, and myocardial infarction, and to have died. In general, differences between males and females were more numerous and striking in whites, especially with respect to lupus nephritis, abnormal serologies, and thrombosis. Conclusion Our study suggests that there are major clinical differences between male and female patients with SLE. Differences between male and female patients also depend on ethnicity. Future SLE studies will need to consider both ethnicity and gender to understand these differences.

Systemic Lupus Erythematosus and Secondary Antiphospholipid Syndrome Diagnosed After Pulmonary Thromboembolism in a Male Patient

“…In general, differences between males and females were more numerous and striking in whites, especially with respect to lupus nephritis, abnormal serologies and thrombosis. 9,10 In a report presented by Cefle et al; in male patients with SLE, renal and pulmonary involvement, cardiomyopathy, serositis, discoid rash, and antiphospholipid syndrome were more frequent and the course of the disease was more severe. 11 It is mentioned that in another study; male patients with SLE present more cardiovascular comorbidities and also more serositis, adenopathies, splenomegaly, renal involvement, convulsion, thrombosis and lupus anticoagulant positivity than women.…”

“…In the same study, anticardiolipin and anti-β2-glycoprotein I antibodies levels were found to be higher, although not reaching statistical significance, and thrombotic events were also seen more frequently in male patients. 10 In another study with a high number of patients; deep vein thrombosis and pulmonary embolism were found to be significantly higher in patients with SLE than in the general population. …”

“…In general, differences between males and females were more numerous and striking in whites, especially with respect to lupus nephritis, abnormal serologies and thrombosis. 9,10 In a report presented by Cefle et al; in male patients with SLE, renal and pulmonary involvement, cardiomyopathy, serositis, discoid rash, and antiphospholipid syndrome were more frequent and the course of the disease was more severe. …”

Development of systemic lupus erythematosus in an elderly male hemodialysis patient with pleuritis

“…Male SLE patients are more likely to have end organ damage, including neuropsychiatric, renal, cardiovascular, peripheral vascular disease, and myocardial infarction. Therefore, males have higher mortality [7]. However, the precise reason for why male SLE appears to be more severe is unknown [8].…”

“…Reportedly, 4-22 % of SLE occurs in males [7]. Male SLE patients are more likely to have end organ damage, including neuropsychiatric, renal, cardiovascular, peripheral vascular disease, and myocardial infarction.…”