Clinical characteristics and outcome of southern Chinese males with systemic lupus erythematosus

The aims were to study the gender differences in clinical manifestations, d isease course and organ damage in systemic lupus erythematosus (SLE). Clinical manifestations, autoantibody profile, relapses and damage scores w ere obtained from 51 Chinese males with SLE and compared with 201 consecuti ve female SLE controls. Fifty-one males were identified among 630 SLE patients who attended our cli nics, giving a male prevalence of 8% and a female to male ratio of 11.4-1. Both the male SLE patients and the female controls had similar age and SLED AI score at disease onset. Male SLE patients had less alopecia (P = 0.03), Raynaud's phenomenon (P = 0.01) and anti-Re (P = 0.049) during the course o f the disease but none of the differences were statistically significant af ter correction for multiple observations. The prevalence of major organ inv olvement in either sex was not different. Both groups of patients had a com parable mean duration of follow-up (104 vs 102 months, P = 0.87). Males had a significantly lower rate of relapses (total No. of flares/patie nt-year: 0.23 in men vs 0.33 in women, P = 0.04), but the frequency of seve re flares (No. of severe flares/patient-year in men 0.08 vs 0.12 in women, P = 0.16) was not significantly different from the females. Male patients w ith positive anti-Re had significantly less overall flares than their femal e counterparts who were anti-Re positive (0.16 vs 0.34, P = 0.006). However , the use of immunosuppressive agents for disease control in patients of bo th sexes was similar. 22 (43%) of the males and 75 (39%) of the females had organ damage. A higher percentage of male patients had impairment of renal function (P = 0.006) but the proportion of patients who required dialysis was not different (4% in men vs 2% in females, P = 0.92). There was also a trend of more cardiovascular damage in the males but the difference was not statistically significant (P = 0.09). The mean SLICC/ACR scores were not s ignificantly higher in the males than the females (0.71 vs 0.60, P = 0.47). Males tend to differ from females in clinical manifestations, immunologica l profile and disease course in SLE. However, there was no gender differenc e in the involvement of major organs/systems. Males had less overall disease flares than the females but the rate of seve re flares was not significantly lower. For patients who were anti-Re positi ve, males had significantly less total number of flares/patient-year than t heir female counterparts. More renal impairment and cardiovascular damage w as present in our male lupus patients but the overall damage scores were no t significantly higher.