Relevance. The proportion of men among patients with systemic lupus erythematosus (SLE) is only 4-22%, but possible differences in the context of the clinical course and prognosis of the disease in this group of patients require more detailed study. Objective: to assess the spectrum of clinical manifestations, autoantibodies and the level of inflammatory markers in men with SLE. Materials and methods. 371 patients with SLE were examined, including 321 women (86.5%) and 50 men (13.5%). Clinical data, SLEDAI index and SLICC/DI damage, levels of inflammatory markers (erythrocyte sedimentation rate, C-reactive protein) and spectrum of specific autoantibodies (antibodies to dsDNA, Sm, Ro/SSA, La/SSB, RNP, antiphospholipid antibodies) were evaluated. Results. Alopecia (18.0% vs 33.0%; p=0.036) and arthralgia (22.0% vs 40.0%; p=0.016) were significantly less common in men with SLE. In contrast, nephritis with nephrotic syndrome was more than three times more common in male SLE patients (14.3%) than in women (4.1%; p=0.032). There was also a difference in the frequency of serositis: men were significantly more likely to have pleurisy (36.7%) than women (21.6%; p=0.044). Nervous system involvement was less common in men (12.0% vs 29.6%; p=0.007), as well as Raynaud's syndrome (16.0% vs 29.8%; p=0.05) and Sjogren's syndrome (0% vs 8.0%, p=0.023) compared with women. However, trophic ulcers were three times more common in men with SLE (14.3% vs 3.5%; p=0.019). Involvement of the mononuclear phagocyte system, heart, lungs, constitutional symptoms, antiphospholipid syndrome, hematological manifestations did not differ significantly between the representatives of both sexes. There were also no gender differences in SLEDAI indices and SLICC damage, erythrocyte sedimentation rate, C-reactive protein, C3, C4 complement levels. Antibodies to Ro/SSA were significantly less common in male SLE patients than in women (23.1% and 58.5%, respectively, p=0.033). Conclusions. Men with SLE are less likely to have alopecia, arthralgia, Raynaud's syndrome, nervous system involvement and Sjogren's syndrome than women. However, males with SLE are more likely to have kidney disease with nephrotic syndrome, pleuritis and trophic ulcers. Presence of anti-Ro/SSA antibodies in men with SLE is less common than in women.

Серцево-судинні захворювання (ССЗ) внаслідок раннього атеросклерозу є провідною причиною смертності у хворих на системний червоний вовчак (СЧВ), що не можна повністю пояснити традиційними факторами ризику ССЗ, прийомом глюкокортикоїдів (ГК) й активністю запального процесу. Жінки віком 35-44 роки, хворі на СЧВ, мають у 50 разів більший ризик ін-фаркту міокарда порівняно зі здоровими жінками [1]. Ранній атеросклероз у 6 разів частіше спостерігається у хворих на СЧВ порівняно із загальною популяцією [2]. Однак клітинні і молекулярні механізми, що лежать в основі раннього атеросклерозу при СЧВ, досі не є пов ністю визначеними [3]. Маркером раннього атеросклерозу вважається ендотеліальна дисфункція (ЕД)потенційно оборотна втрата нормальної судинної ре

2.2 Clinical phenotypes of systemic lupus erythematosus with regard to age at disease onset Background. Systemic lupus erythematosus (SLE) is an obscure autoimmune disease distinguished by the wide variation in its clinical and immunological characteristics, with several factors contributing to the disease heterogeneity including the influence of female sex hormones [113]. Hence SLE most frequently develops in the second through fourth decades of life, predominantly in women of childbearing age [114].However, nearly 20% of cases present during childhood, generally after puberty (juvenileonset SLE, JSLE) [115]. On the other hand, 10-20% of patients develop SLE after the age of 45-50 years (late-onset SLE, LSLE) [116].The findings about influence of age at disease onset on the clinical presentation of SLE are not always consistent across the studies. In particular, most previous studies indicate a more severe phenotype in JSLE due to higher disease activity and major organ involvement, namely renal, neuropsychiatric and hematological [117, 118]. Moreover, JSLE is associated with presence of greater damage at the time of diagnosis and is more often treated with higher doses of glucocorticoids and immunosuppressive medications, contributing to the increased morbidity and mortality when compared with adult-onset SLE (ASLE) [119]. On the other hand, LSLE patients tend to have more insidious onset of disease and less major organ involvement. However, they have a poorer prognosis due to higher frequency of comorbidities and extended exposure to cardiovascular risk factors [120][121][122].Although the age at diagnosis has a strong modulating effect on clinical presentation, disease course, response to treatment and prognosis, the findings are not always consistent across studies due to geographic and ethnic variations. Data about autoantibody profiles and inflammatory markers across age groups also remain conflicting [123][124][125][126][127].Objectives. The aim of this study was to evaluate the spectrum of clinical manifestations and autoantibody profile in patients with SLE in the central region of Ukraine regarding age at onset.

Background. Damage of the joints is one of the typical and often the first signs of systemic lupus erythematosus (SLE), however the peculiarities the of clinical and laboratory changes in patients without articular manifestations (AM) remain insufficiently studied. The purpose was to study the frequency of AM in the patients with SLE and to evaluate its interconnection with clinical and laboratory manifestations of the disease. Materials and methods. 376 patients with SLE were examined. 2 groups were formed: I — with AM presented as arthritis and/or arthralgia at the time of application (n = 316), II — without AM (n = 60). The involvement of various organs and systems, as well as the levels of inflammatory markers and the spectrum of specific autoantibo­dies, were evaluated. Results. Patients with SLE and AM had erythematous rash on the face in the form of a “butterfly” more often than the patients without AM (34.1 vs. 20.0 %, p = 0.04). Serositis was more often observed in patients with AM (39.6 %) compared to the patients without AM (25.4 %, p = 0.048). Nephritis with nephrotic syndrome was 4 times more frequent in patients without arthritis/arthralgia compared to the subjects with AM (10.2 vs. 2.6 %, p = 0.04). The frequency of antiphospholipid syndrome was also significantly higher in patients without AM (25.5 vs. 6.0 %, p < 0.001). The group of the patients with SLE and AM had a hi­gher frequency of Raynaud’s syndrome (27.5 vs. 15.0 %, p = 0.046), lymphadenopathy (50.5 vs. 35.6 %, p = 0.048), heart involvement (62.5 vs. 42.4 %, p = 0.007), weight loss (13.6 vs. 3.8 %, p = 0.04) and positivity for antibodies to dsDNA (65.0 vs. 45.7 %, p = 0.03), than the patients without AM. The median va­lue of SLEDAI was significantly higher in the patients with SLE and AM (11 (6–16) points vs. 7.5 (4–14) points, р = 0.01). Also they received significantly higher doses of oral glucocorticoids (10 (10–20) mg/d in prednisolone equivalent) compared to the subjects without AM (6.25 (3.75–12.5) mg/d, p = 0.01). Conclusions. Rash on the face in the form of a “butterfly”, serositis, heart involvement, lymphadenopathy, Raynaud’s syndrome, weight loss, and anti-dsDNA positivity are significantly more common in SLE patients with AM. Nephritis with nephrotic syndrome and antiphospholipid syndrome occur more often in patients with SLE without AM. Presence of arthritis/arthralgia in patients with SLE is associated with a higher index of disease of activity and the need for higher doses of glucocorticoids.

Objective: Early-onset atherosclerosis with cardiovascular (CV) sequelae is the major cause of death in systemic lupus erythematosus (SLE); that cannot be explained only by traditional Framingham risk factors as SLE-related factors may also have an impact. The present study aimed to analyze the determinants of atherosclerosis development and risk factors modification by statin therapy in SLE patients. Design and method: This prospective randomized study included 100 SLE patients aged 40.9±1.4 years (90 females, 10 males) and 32 age-, sex-matched healthy controls. Brachial artery flow-mediated dilation (FMD), ultrasound of extracranial and peripheral arteries, and cardiac calcium scoring were used for the identification of atherosclerosis. 52 SLE patients with dyslipidemia were randomized to receive simvastatin 40 mg/day (n = 27) or placebo (n = 25). Lipid panel, FMD, and inflammatory markers were assessed at baseline and after 6 months. Results: The mean duration of SLE was 9.9±0.88 years. The disease activity index (SLEDAI) and SLE damage score (SLICC) were 11.8±0.6 and 1.85±0.13 points, respectively. In 66% of SLE patients, atherosclerosis was present in at least one vascular area which was 3.5 times more frequently compared with controls. Atherosclerosis of carotid arteries was detected in 41% of SLE patients, lower limb arteries, and coronary arteries in 58% and 39% of patients, respectively. FMD was significantly decreased in SLE patients compared to controls (7.95±0.49% vs 11.6±0.3%, p<0.001). In multiple linear regression, age (p<0.001), nephritis (p = 0.001), polyarthritis (p = 0.019), and Raynaud's syndrome (p = 0.045) were associated with low FMD. In binary logistic regression, independent determinants of the atherosclerosis development in SLE were age (p<0.001), body mass index (BMI) (p = 0.001), anti-dsDNA (p = 0.023), FMD (p = 0.017) and malar rash (p = 0.02). After simvastatin treatment, the level of LDL-Cholesterol reduced by 42%, erythrocyte sedimentation rate, C-reactive protein, and interleukin-6 decreased by 34.7%, 51.1%, and 47.7% respectively, while FMD increased by 26.0% (p<0.05); in the placebo group, there were no significant changes. Conclusions: The independent determinants of atherosclerosis in SLE patients were both traditional CV risk factors (age, BMI) and SLE-specific factors (anti-dsDNA, malar rash, FMD). In SLE patients with dyslipidemia, simvastatin may have not only lipid-lowering but also potentially anti-inflammatory benefits.