Abstract
ObjectiveSystemic 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.MethodsWe 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.ResultsFemale 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).ConclusionSLE 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.
Highlights
Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by multi-organ involvement, dysregulated autoantibody production, and activation of the type I interferon system [1,2,3,4,5]
In the present study, we aimed at describing sex differences in the clinical presentation of SLE in a large and well-characterized group of patients with a special focus on renal involvement, a potentially severe manifestation observed more frequently among male patients
Patients in the study The study population consisted of 1226 patients (1060 women and 166 men) of the DISSECT program [22], out of which 1170 fulfilled at least 4 of the 1982 American College of Rheumatology (ACR) classification criteria [33], and the additional 56 cases had a clinical diagnosis of SLE and fulfilled the Fries’ diagnostic principle for SLE [34]
Summary
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
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