Background Systemic lupus erythematosus (SLE) is a multisystemic autoimmune disorder that disproportionally affects women and is known to occur rarely in men. This difference may be explained by estrogenic effect and ethnicity. Clinical outcomes including renal involvement, disease activity, damage accrual and mortality seem to be more severe in males (1,2). These factors associated with adverse outcomes in males vary among patients from different ethnic backgrounds (1,2,3). Few studies have been performed in Mexican population (4).
Objectives To examine the differences and associated factors of clinical outcomes in males with SLE from a Mexican cohort.
Methods 131 SLE patients (≥16 years) from a Mexican cohort from 2011 to 2014 were examined. SLE cases fulfilled 4 of SLICC 2012 criteria. Demographic factors, Disease Activity Index (SLEDAI), Systemic Lupus International Collaborating Clinics Damage Index (SLICC), mortality, comorbidities and pharmacologic treatments were examined for SLE patients by gender. Variables were examined by univariable and multivariable analyses.
Results Of 131 SLE patients, 11 (8.4%) were men. The ratio of female to male patients was 11:1. The mean age [standard deviation (SD)] for women was 38.9 (1.26) years and for men was 40.6 (6.24) years. The mean of time at onset of SLE in women was 7.08 (0.75) and in men 6.55 (1.75) years, respectively. In univariable analyses male SLE patients compared with women were more likely to had lower levels of education, more frequently to present renal involvement, disease activity, damage accrual and mortality; further comorbidities as peripheral vascular disease and arterial hypertension; to use more commonly maximum doses of glucocorticoids, mycophenolate mofetil, cyclophosphamide and rituximab; also more probably to show anti-Ro and lupus anticoagulant antibody. In the multivariable analyses to have less renal involvement (OR 0.33, 95% CI 0.12-0.85, p=0.05), less accrual damage (OR 0.46, 95% CI 0.25-0.82, p=0.008), and less arterial hypertension (OR 0.06, 95% CI 0.06-0.68, p=0.023) remained significant as protective factors.
Conclusions This study as other previous reports suggests that in Mexican population with SLE exist differences in clinical outcomes as renal involvement, activity disease damage accrual and mortality between males and females. However, these observations must be confirmed in larger and prospective studies with more rigorous methodology.
J Rheumatol. 2012 Apr;39(4):759-69.
Clin Exp Rheumatol. 2010 May-Jun;28(3):297-9.
Clin Exp Rheumatol. 2004 Nov-Dec;22(6):713-21.
Disclosure of Interest None declared