Some key differences found in lupus symptoms in men vs. women: Study

Men at higher risk of heart attack; women more likely to have arthritis

Marisa Wexler, MS avatar

by Marisa Wexler, MS |

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Men with systemic lupus erythematosus (SLE) are more likely to experience kidney failure and heart attacks, while women with SLE are at higher risk of other symptoms, such as skin problems and arthritis, according to a new study.

“Generally, our study suggests that men have the same spectrum of disease manifestations, but a possibly a difference in prevalence of certain manifestations than women,” the researchers wrote.

While men specifically were found to have a greater risk of cardiovascular problems — most notably, coronary arterial disease and heart attacks — the data showed they were “less likely to have arthritis and dermatological manifestations, especially photosensitivity than women,” the team noted.

The study, “Worse cardiovascular and renal outcome in male SLE patients,” was published in Scientific Reports.

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SLE predominantly affects women — roughly 90% of SLE patients are female. Whether there are differences in how the disease manifests in people of different biological sexes has been unclear, however.

“Differences between male and female SLE described in the literature remain controversial and further investigation are needed,” the researchers wrote, noting that “this motivated us to study in more detail sex differences in SLE.”

To learn more, the scientists analyzed data on 622 people with SLE who were treated at centers in Switzerland. Of them, 529 were women and 93 — just less than 15% — were men. Among both sexes, more than 80% of patients were white individuals.

“This was the first of its kind in a western European population,” the researchers wrote of their study, adding that these data “provide information for clinicians in other western European populations of which other SLE cohorts reported similar ethnical background.”

On average, male SLE patients tended to be significantly older when they were diagnosed than were female patients (44.4 vs. 33.1 years). The time between first onset of symptoms and diagnosis was similar across the sexes, so this suggests men who develop lupus tend to do so later in life than women.

Compared with their female counterparts, male lupus patients had lower rates of skin-related symptoms (61% vs. 76%) and arthritis (57% vs. 74%), and statistical models suggested the risk of these issues was significantly reduced among SLE men even after accounting for other factors. Photosensitivity, or immune system reactions to sunlight, was significantly higher among women versus men.

Psychosis, or losing contact with reality, which was rare overall, also was less common in male than female patients (1% vs. 6%).

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More kidney failure in men, but difference not statistically significant

However, men with lupus had markedly higher rates of coronary arterial disease (17% vs. 4%), which refers to disease that affects the blood vessels that supply blood to the heart. Rates of myocardial infarction, or heart attack, also were significantly higher in male patients than female patients (10% vs. 2%).

Statistical models showed male patients were at significantly increased risk of these heart health problems, even after accounting for other factors that affect heart health, such as high blood pressure and diabetes.

The researchers noted that, in the general population, men are known to be at increased risk of heart health problems. But such an increase in males with SLE “seems to be higher than the reported risk difference in general population,” suggesting that disease-specific factors also are likely at play, the researchers said.

The risk of kidney failure also was notably increased among men, but this difference was not statistically significant after accounting for heart health risk factors like diabetes and blood pressure.

“This finding suggests that sex is not a sole risk factor for renal failure, but to some degree dependent on additional cardiovascular risk factors,” the researchers wrote.

Further research in this area is needed and could lead to a better understanding of the etiology [cause] of SLE in general and help provide sex specific treatment options.

Mortality rates were higher for male patients, but this difference was not significant after accounting for the fact that men tended to be older when they got SLE. The researchers noted that less than two dozen patients died during follow-up, so it’s impossible to make firm conclusions about the effect of sex on mortality risk based on this study.

The team also said that, while these data suggest clear differences in how SLE tends to affect men and women, it remains unclear why these differences exist. Presumably, biological differences between sexes in hormones and chromosomes have some effect, but sociological factors like differences in behavior also may play a role.

“Further research in this area is needed and could lead to a better understanding of the etiology [cause] of SLE in general and help provide sex specific treatment options,” the researchers concluded.