Clinical Features of Systemic Lupus Erythematosus in Tunisian Males

Abstract

Purpose: Systemic Lupus Erythematosus (SLE) in males is rare. Clinical and biological features, as well as, the outcome may differ comparatively to female patients. The purpose of our study is to define these clinical and biological features in Tunisian male patients presenting SLE. Methods: A mono-centric, retrospective and descriptive study of 96 patients followed for SLE out of which 21 are males. A comparative study was then performed between male and female patients groups. Results: Sex-ratio female/male was 3.6/1, the average age at diagnosis of SLE was 37.8±14 years. The most frequently noted clinical manifestations were: skin involvement (81%), renal involvement (71.4%) and joint damage (66.7). We observed a significant difference in clinical features between male and female patients (21 males and 76 females): renal failure (52% vs. 71.4%), serositis (23.8% vs. 2.7%), peripheral neuropathy (19% vs. 4%) and lung interstitial disease (14.3% vs. 1.3%). No significant difference was found in the positivity of serum antibodies between the two groups. Fifteen male patients (71.4%) had a SLEDAI score greater than or equal to 11, referring to high/very high disease activity. Out of the 32 patients who developed infectious complications during the course of the disease, 11 were male (52.4% of males). Concerning the male group, complete remission was observed in 10 patients (47.6%), while 10 others presented persistent sequella. We observed one death in the male group secondary to infective acute respiratory failure. Conclusion: SLE in male patients is rare and associated with poor prognosis. Disparity was observed in clinical and biological features as well as outcome in the different studies. In our study, we concluded that male lupus is more severe.

Sex hormones affect the pathogenesis and clinical characteristics of systemic lupus erythematosus

“…Lupus anticoagulant positivity is more common in men, combined with smoking and alcohol use, which is related to a higher prevalence of thrombosis in male SLE than in female SLE ( 96 – 98 ). Additionally, renal, hematological, and neurological involvement, as well as serositis features prominently in male SLE, leading to rapid organ damage compared to female SLE ( 94 , 99 ). The increase in autoantibody production and the development of lupus nephritis in male SLE is presumed to be due to the global deletion of ERα or especially in B cells ( 98 ).…”

“…In relation to disease activity, SLEDAI scores and lupus severity of disease index scores did not differ significantly between the sexes in most studies (90,94,95,98,104). Conversely, renal damage is a major concern in male SLE, as several studies reported that male sex is a strong predictor of baseline damage and men have a high risk of developing chronic renal failure (91,92,(105)(106)(107)(108)(109).…”

“…Serologically, anti-dsDNA and anti-Smith antibodies have been observed to occur more frequently in male SLE, whereas some studies have reported lower levels of anti-Ro/SSA and anti-La/SSB antibodies in male SLE (92)(93)(94)(95). Although differences occur depending on the reported group, anti-U1-RNP and anticardiolipin antibodies and low complement appear to occur at almost the same rates in men and women (92,96).…”

“…Regarding skin involvement, discoid, and subacute lesions occurred more frequently in male SLE, while malar rash, photosensitivity, and Raynaud's phenomenon were much less common (74,90,92,(94)(95)(96)(97)(98)(99)(100)(101)(102)(103)(104). Musculoskeletal involvement and alopecia were reported less frequently in male SLE, with fewer outpatient visits and emergency department visits than in female SLE (93,101,105).…”

Macrophage colony-stimulating factor could evaluate both disease activity and renal involvement in systemic lupus erythematosus

“…All participants met the 1997 American College of Rheumatology (ACR) revised criteria for the classification of SLE (26); SLE patients with cancer, infectious diseases, and other rheumatic diseases, were excluded. For some analyses, the 100 SLE patients were divided into an inactive group (n=50) and an active group (n=50) according to their SLEDAI score [if ≥10, they were considered clinically active (27)]. For other analyses, these participants were grouped into a non-lupus nephritis group (non-LN, n=52) and lupus nephritis group (LN, n=48) according to the results of renal biopsy in department of pathology in our hospital [including1 class II, 9 class III, 25 class IV, 6 class V, 5 class III + V, and 2 class VI, using the International Society of Nephrology/Renal Pathology Society (ISN/RPS) 2003 lupus nephritis classification (28)].…”