Gender impact in systemic lupus erythematosus

M.E. Soto, M. Vallejo, F. Guillén, J.A. Simón1, E. Arena, P.A. Reyes

Instituto Nacional de Cardiología "Ignacio Chávez" and 1Instituto Nacional de Ciencias Médicas y Nutricion "S. Zubiran", Tlalpan, México

ABSTRACT
Objective

Systemic Lupus Erythematousus (SLE), an autoimmune disease of unknown etiology manifesting as a pleomorphic systemic disease, affects mostly females, (female:male ratio 9:1). Clinical differences between genders, including a higher death rate in males, has been reported. Here we compared clinical manifestations and the 5-year survival probability in Mexican male and female crossbred cases living under similar socioeconomic conditions. A systematic review of published literature was also carried out.

Material and Methods
SLE patients treated at the Instituto Nacional de Cardiología "Ignacio Chávez" México City who fulfilled at least four classification criteria (ACR) were included. The frequency of clinical variables with emphasis on cardiovascular findings before and after the diagnosis were described, disease activity based on a validated scale (SLEDAI) was determined, and the 5-year survival rate was estimated. 

Results
There were 33 men and 158 women, average age of 31 in both groups ranging from 7 to 65 and from 10 to 75 year in male and female patients respectively; both groups were followed for 3.8 years (median), average activity was of 12 points with a range of 5 to 23 in men, and 11 with a range of 2 to 24 in women. Main clinical characteristics in men were: discoid lupus, psychosis, pericarditis, lymphopenia, thrombocytopenia and SLE kidney disease. Immunological tests showed gender-linked differences in regard auto-antibodies (U1-nRNP, Sm, anticardiolipine and false VDRL) and hypocomplementemia. Cardiovascular features and survival rate were not different between gender. 

Conclusion
Male Mexican SLE patients share clinical findings with other male SLE cases reported everywhere as can be deducted from systematic literature review covering 25-year. 

Key words
Systemic Lupus Erythematosus (SLE), gender difference, male disease, ethnicity, survival rate and systematic literature review.


Please address correspondence and reprint requests to: Dr. Pedro A. Reyes, Dirección de Investigación, Instituto Nacional de Cardiología "Ignacio Chávez", Juan Badiano #1, Col. Sección XVI, Tlalpan, México D.F. 14080.

Clin Exp Rheumatol 2004; 22: 713-721.
© Copyright Clinical and Experimental Rheumatology 2004.