Male Systemic Lupus Erythematosus: Gender Differences in Clinical Characteristics

Sharifah Aishah, Wan Mohamad Akbar and Teh, Cheng Lay and Cheong, Yaw Kiet and Ling, Guo Rey and Chuah, Seow Lin and Ahmad Tirmizi, Jobli (2023) Male Systemic Lupus Erythematosus: Gender Differences in Clinical Characteristics. Journal of Men’s Health, 19 (12). p. 128. ISSN 1875-6867

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Abstract

Introduction: Systemic lupus erythematosus (SLE) is a multisystemic autoimmune disease with a higher prevalence in women. The aetiology for this gender difference is unknown, but several studies have shown that despite the higher prevalence of SLE in women, men with SLE have more renal involvement and more severe disease than women. Aim: To examine the clinical characteristics of male SLE patients, and the gender difference between men and women with SLE. Methods: SLE patients in rheumatology units in Sarawak General Hospital and Sibu Hospital were included in the study from July 2018 until November 2021, and the differences in demographics, age at onset, clinical manifestations, and SLE damage index were examined. All patients fulfilled the 2012 Systemic Lupus International Collaborating Clinics (SLICC) Classification Criteria for Systemic Lupus Erythematosus. Results: There were 866 patients, with 779 (90%) women and 87 (10%) men. There were more smokers among men (18 (20.7%) men vs. 12 (1.5%) women, p < 0.01). Men had significantly more renal involvement (58 (66.7%) men vs. 420 (53.9%) women, p = 0.02). Men also had more severe disease at SLE diagnosis (58 (66.7%) men vs. 421 (54.0%) women, p = 0.03). Women had significantly more oral or nasal ulcers (330 (42.3%) women vs. 25 (28.7%) men, p = 0.01), non-scarring alopecia (451 (57.8%) women vs. 25 (28.7%) men, p < 0.01), arthritis (319 (40.9%) women vs. 26 (29.9%) men, p = 0.05), and leucopenia (403 (51.7%) women vs. 35 (40.2%) men, p = 0.04). There were no significant differences in mean age at SLE diagnosis (30.2 ± 13.2 years in women vs. 30.4 ± 13.1 years in men, p = 0.9). There were no difference in deaths, with 74 (9.5%) deaths among women and 13 (14.9%) among men, p = 0.1. The presence of disease damage (SLE damage index (SLICC SDI) score >1) did not differ significantly between men and women (men 35 (40.2%) vs. women 294 (37.7%), p = 0.65). However, there was a significant statistical difference seen between men and women in individual damage index items (end stage renal failure, myocardial infarction, gastrointestinal infarction and extensive skin scarring). Conclusions: Male SLE patients tend to have more severe disease at SLE presentation, more renal involvement and more disease damage compared to female SLE patients.

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