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Multicenter Study
. 2019 Dec 16;10(1):60.
doi: 10.1186/s13293-019-0274-2.

Sex Differences in Clinical Presentation of Systemic Lupus Erythematosus

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Free PMC article
Multicenter Study

Sex Differences in Clinical Presentation of Systemic Lupus Erythematosus

Jorge I Ramírez Sepúlveda et al. Biol Sex Differ. .
Free PMC article

Abstract

Objective: Systemic lupus erythematosus (SLE) predominantly affects women, but previous studies suggest that men with SLE present a more severe disease phenotype. In this study, we investigated a large and well-characterized patient group with the aim of identifying sex differences in disease manifestations, with a special focus on renal involvement.

Methods: We studied a Swedish multi-center SLE cohort including 1226 patients (1060 women and 166 men) with a mean follow-up time of 15.8 ± 13.4 years. Demographic data, disease manifestations including ACR criteria, serology and renal histopathology were investigated. Renal outcome and mortality were analyzed in subcohorts.

Results: Female SLE patients presented more often with malar rash (p < 0.0001), photosensitivity (p < 0.0001), oral ulcers (p = 0.01), and arthritis (p = 0.007). Male patients on the other hand presented more often with serositis (p = 0.0003), renal disorder (p < 0.0001), and immunologic disorder (p = 0.04) by the ACR definitions. With regard to renal involvement, women were diagnosed with nephritis at an earlier age (p = 0.006), while men with SLE had an overall higher risk for progression into end-stage renal disease (ESRD) with a hazard ratio (HR) of 5.1 (95% CI, 2.1-12.5). The mortality rate among men with SLE and nephritis compared with women was HR 1.7 (95% CI, 0.8-3.8).

Conclusion: SLE shows significant sex-specific features, whereby men are affected by a more severe disease with regard to both renal and extra-renal manifestations. Additionally, men are at a higher risk of developing ESRD which may require an increased awareness and monitoring in clinical practice.

Conflict of interest statement

The authors declare that they have no competing interests.

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References

    1. Wahren-Herlenius M, Dorner T. Immunopathogenic mechanisms of systemic autoimmune disease. Lancet. 2013;382:819–831. doi: 10.1016/S0140-6736(13)60954-X. - DOI - PubMed
    1. Hassan AB, Lundberg IE, Isenberg D, et al. Serial analysis of Ro/SSA and La/SSB antibody levels and correlation with clinical disease activity in patients with systemic lupus erythematosus. Scand J Rheumatol. 2002;31:133–139. doi: 10.1080/rhe.31.3.133.139. - DOI - PubMed
    1. Pourmand N, Wahren-Herlenius M, Gunnarsson I, et al. Ro/SSA and La/SSB specific IgA autoantibodies in serum of patients with Sjogren's syndrome and systemic lupus erythematosus. Ann Rheum Dis. 1999;58:623–629. doi: 10.1136/ard.58.10.623. - DOI - PMC - PubMed
    1. Popovic K, Nyberg F, Wahren-Herlenius M, et al. A serology-based approach combined with clinical examination of 125 Ro/SSA-positive patients to define incidence and prevalence of subacute cutaneous lupus erythematosus. Arthritis Rheum. 2007;56:255–264. doi: 10.1002/art.22286. - DOI - PubMed
    1. Eloranta ML, Ronnblom L. Cause and consequences of the activated type I interferon system in SLE. J Mol Med. 2016;94:1103–1110. doi: 10.1007/s00109-016-1421-4. - DOI - PMC - PubMed

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