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Sex differences in clinical presentation of systemic lupus erythematosus

Ramírez Sepúlveda, Jorge I. ; Bolin, Karin ; Mofors, Johannes ; Leonard, Dag ; Svenungsson, Elisabet ; Jönsen, Andreas LU ; Bengtsson, Christine LU ; Nordmark, Gunnel ; Rantapää Dahlqvist, Solbritt and Bengtsson, Anders A. , et al. (2019) In Biology of Sex Differences 10(1).
Abstract

Objective: Systemic lupus erythematosus (SLE) predominantly affects women, but previous studies suggest that men with SLE present a more severe disease phenotype. In this study, we investigated a large and well-characterized patient group with the aim of identifying sex differences in disease manifestations, with a special focus on renal involvement. Methods: We studied a Swedish multi-center SLE cohort including 1226 patients (1060 women and 166 men) with a mean follow-up time of 15.8 ± 13.4 years. Demographic data, disease manifestations including ACR criteria, serology and renal histopathology were investigated. Renal outcome and mortality were analyzed in subcohorts. Results: Female SLE patients presented more often with malar rash... (More)

Objective: Systemic lupus erythematosus (SLE) predominantly affects women, but previous studies suggest that men with SLE present a more severe disease phenotype. In this study, we investigated a large and well-characterized patient group with the aim of identifying sex differences in disease manifestations, with a special focus on renal involvement. Methods: We studied a Swedish multi-center SLE cohort including 1226 patients (1060 women and 166 men) with a mean follow-up time of 15.8 ± 13.4 years. Demographic data, disease manifestations including ACR criteria, serology and renal histopathology were investigated. Renal outcome and mortality were analyzed in subcohorts. Results: Female SLE patients presented more often with malar rash (p < 0.0001), photosensitivity (p < 0.0001), oral ulcers (p = 0.01), and arthritis (p = 0.007). Male patients on the other hand presented more often with serositis (p = 0.0003), renal disorder (p < 0.0001), and immunologic disorder (p = 0.04) by the ACR definitions. With regard to renal involvement, women were diagnosed with nephritis at an earlier age (p = 0.006), while men with SLE had an overall higher risk for progression into end-stage renal disease (ESRD) with a hazard ratio (HR) of 5.1 (95% CI, 2.1-12.5). The mortality rate among men with SLE and nephritis compared with women was HR 1.7 (95% CI, 0.8-3.8). Conclusion: SLE shows significant sex-specific features, whereby men are affected by a more severe disease with regard to both renal and extra-renal manifestations. Additionally, men are at a higher risk of developing ESRD which may require an increased awareness and monitoring in clinical practice.

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type
Contribution to journal
publication status
published
subject
in
Biology of Sex Differences
volume
10
issue
1
article number
60
publisher
BioMed Central (BMC)
external identifiers
  • scopus:85076675256
  • pmid:31843005
ISSN
2042-6410
DOI
10.1186/s13293-019-0274-2
language
English
LU publication?
yes
id
21e5abec-3acf-4eb6-b7d3-a08b257e202c
date added to LUP
2020-01-03 13:00:42
date last changed
2020-10-27 01:40:46
@article{21e5abec-3acf-4eb6-b7d3-a08b257e202c,
  abstract     = {<p>Objective: Systemic lupus erythematosus (SLE) predominantly affects women, but previous studies suggest that men with SLE present a more severe disease phenotype. In this study, we investigated a large and well-characterized patient group with the aim of identifying sex differences in disease manifestations, with a special focus on renal involvement. Methods: We studied a Swedish multi-center SLE cohort including 1226 patients (1060 women and 166 men) with a mean follow-up time of 15.8 ± 13.4 years. Demographic data, disease manifestations including ACR criteria, serology and renal histopathology were investigated. Renal outcome and mortality were analyzed in subcohorts. Results: Female SLE patients presented more often with malar rash (p &lt; 0.0001), photosensitivity (p &lt; 0.0001), oral ulcers (p = 0.01), and arthritis (p = 0.007). Male patients on the other hand presented more often with serositis (p = 0.0003), renal disorder (p &lt; 0.0001), and immunologic disorder (p = 0.04) by the ACR definitions. With regard to renal involvement, women were diagnosed with nephritis at an earlier age (p = 0.006), while men with SLE had an overall higher risk for progression into end-stage renal disease (ESRD) with a hazard ratio (HR) of 5.1 (95% CI, 2.1-12.5). The mortality rate among men with SLE and nephritis compared with women was HR 1.7 (95% CI, 0.8-3.8). Conclusion: SLE shows significant sex-specific features, whereby men are affected by a more severe disease with regard to both renal and extra-renal manifestations. Additionally, men are at a higher risk of developing ESRD which may require an increased awareness and monitoring in clinical practice.</p>},
  author       = {Ramírez Sepúlveda, Jorge I. and Bolin, Karin and Mofors, Johannes and Leonard, Dag and Svenungsson, Elisabet and Jönsen, Andreas and Bengtsson, Christine and Nordmark, Gunnel and Rantapää Dahlqvist, Solbritt and Bengtsson, Anders A. and Rönnblom, Lars and Sjöwall, Christopher and Gunnarsson, Iva and Wahren-Herlenius, Marie},
  issn         = {2042-6410},
  language     = {eng},
  month        = {12},
  number       = {1},
  publisher    = {BioMed Central (BMC)},
  series       = {Biology of Sex Differences},
  title        = {Sex differences in clinical presentation of systemic lupus erythematosus},
  url          = {http://dx.doi.org/10.1186/s13293-019-0274-2},
  doi          = {10.1186/s13293-019-0274-2},
  volume       = {10},
  year         = {2019},
}