Background Systemic lupus erythematosus (SLE) is less frequent in men than in women, but it can be more severe.
Objectives To determine if the outcome of SLE and its treatment differ between men and women.
Methods We calculated the SLICC scores (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index) of 236 patients diagnosed as SLE between 1988 and 2000. Anti-ENA antibodies (U1-RNP, Sm, Ro, and La) were studied by ELISA in the first available serum sample for each patient. The SLE disease activity index (SLEDAI) of the first hospital study was calculated retrospectively.
Results Twenty-five (10.5%) of the 236 patients were men. Age, age at onset of SLE, duration of the disease, and SLEDAI score at the onset of the disease were similar in the men and women. There was no difference in the frequency of anti-ENA antibodies between the sexes. The SLICC cumulative tissue damage score obtained at the last follow-up visit was significantly higher in men (2.24; SD 1.89) than in women (1.40; SD 1.86) (Mann-Whitney p:0.009). Kidney disease, whether characterised by clearance of less than 50% of normal (9 of 25; 36% vs 23 of 211; 10.9%) (OR: 4.5) or proteinuria over 3.5 g/day and need for dialysis and transplantation (14 of 25; 56% vs 49 of 211; 23.2%) (OR: 4.2), was significantly more frequent in men (OR: 3.8). Cardiomyopathy (3 of 25; 12% vs 3 of 211; 1.4%) (OR: 9.4), avascular necrosis (3 of 25; 12% vs 3 of 211; 1.4%) (OR: 9.4), and retinal disorders (2 of 25; 8% vs 1 of 211; 0.5%) (OR: 18.2) also were more frequent in men than women. In the follow-up period, 5 of the 25 men died (20%) but only 3 of the 211 women died (1.4%) (Fisher p:0.005; OR: 17.33; IC 95%: 3.8–77.9).
Conclusion Mortality and the tissue damage scores were significantly greater in men with SLE than in women. The higher SLICC score was due mainly to the greater frequency of kidney and heart disease.
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