Background Female preponderance is a well-known characteristic of systemic lupus erythematosus (SLE). Males with SLE are a minority group but distinguishable characteristics have been reported. Gender may influence the clinical features and outcome of SLE patients.
Objectives To investigate the clinical characteristics and outcome in Korean male SLE patients compared to female patients and to analyze the gender impact on the presenting features and outcome.
Methods We performed a retrospective analysis using medical records at a single tertiary hospital between August 1994 and May 2010. Each male patient was matched with 3 female SLE patients for age and disease duration. Clinical and serologic features at the disease onset and during the course of disease were compared between the groups. SLE severity was assessed using the Severity of Disease Index (SDI). The assessment of organ damage was made using the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC/ACR DI).
Results Among total of 632 patients with SLE, 57 males were identified. The ratio of female to male was 11.6:1. The mean time to SLE diagnosis was 23.2±43.3 months for males and 8.9±10.5 months for females (p=0.001). The mean age at diagnosis was 32.7±12.1 years-old and the mean duration of follow-up was 55.3±51.1 months for both groups. The 5- and 10- year survival rates of male lupus were 90% and 90% compared to 95.9% and 94.2% of female lupus (p=0.11). Male lupus patients had less discoid rash (p=0.005), alopecia (p=0.010), leucopenia (p<0.001) and anti-Ro (p<0.001) at the onset of disease but renal disorder was more prevalent in male lupus (p<0.001). The adjusted odds ratio (OR) demonstrated a significant gender difference for discoid rash (OR 0.34, 95% confidence interval (CI) 0.14 - 0.81) and renal disorder (OR 3.26, 95% CI 1.62 - 6.57). In male lupus, high-dose of corticosteroid and immunosuppressive agents for disease control were used more frequently compared to female (62.7% vs. 32.7, p<0.001 and 74.5% vs. 46.7%, p=0.001). Male lupus patients had a higher percentage of diffuse proliferative lupus nephritis (p=0.025) and end-stage renal disease (ESRD) which required dialysis (p<0.001) during the course and the risk for dialysis were significantly elevated (OR 4.02, 95% CI 1.07 - 15.06). There was no difference in the neuropsychiatric and cardiovascular damage between male and female lupus (p=0.62 and p=0.52). In male lupus, the mean SDI and SLICC/ACR DI were significantly higher (4.44±2.69 vs. 3.45±2.03, p=0.011 and 1.55±1.35 vs. 1.02±1.57, p=0.028).
Conclusions Our data shows a significant gender effect in the clinical features and outcome of Korean male SLE. Delayed diagnosis was observed in male SLE patients and higher frequency of renal disorder including diffuse proliferative lupus nephritis and dialysis-required ESRD was demonstrated. Male SLE was more severe and more organ damage was present in male SLE.
Disclosure of Interest None Declared
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