Effect of Gender on Clinical Presentation in SLE
Effect of Gender on Clinical Presentation in SLE
Life expectancy of patients with SLE is reduced in comparison with that of an age-matched general population. The suggestion by some that a number of aspects of disease thought to carry a worse prognosis, notably renal disease, are amplified in men might suggest that mortality rates would be increased in men with SLE.
Interestingly among those studies that have addressed this outcome measure, the most consistent finding is that the overall mortality rates in men are comparable to those in women. Of the studies that have addressed mortality rates, four found no difference overall between male and female patients and three suggested an increase in mortality in male patients. Tan et al. showed that the mortality rate was significantly elevated in male lupus patients, with a mortality rate of 11.5% in comparison with 6.2% in the female cohort. Prete et al. also found an elevated mortality rate in males, but only within the first year after diagnosis. It should be highlighted that the latter study of the US veteran population included an older population, and the male cohort was significantly older than the female cohort. Specifically men had increased rates of myocardial infarction and neoplasia. Finally, Wang et al. reported higher rates of mortality in men with LN; however, this study had a small number of male subjects, which limits its power to detect a statistically relevant effect. The causes of death outlined in both these and other studies, which did not detect a difference by gender, included both SLE-specific and other causes. The low overall numbers do not permit a conclusive analysis of whether SLE-specific mortality is more associated with male gender and this needs to be addressed in prospective cohorts of greater duration.
Given the magnified cardiovascular risk recognized in SLE patients, it is an interesting variable to study as it may confer an increased risk over a longer time frame than may be captured within current studies. Many use the term cardiovascular disease as an all-embracing term to encompass a spectrum of disease from arterial hypertension to angina/myocardial infarction. A number of studies have shown that cardiovascular disease is amplified in men with SLE. In particular, in a few studies male gender has been associated with greater hypertension, angina, MI and even CVA in early disease. Whether this reflects the general enhanced cardiovascular risk in the male population or is further magnified by the inflammatory state of SLE in men is unknown.
Previous evidence also emphasizes the importance of capturing information on SLE-related damage as a prognostic indicator, with elevated damage scores associated with greater mortality. Of the many studies that have included information on damage, only one showed an association between male gender and damage at baseline, with a shorter time to accrual of further damage. Certainly the evidence from research to date is that despite the suggestion of greater frequencies of particular organ involvement in male subjects of certain ethnicities, this is not reflected in the limited information on mortality and morbidity captured by the SLICC index.
Morbidity/Mortality
Life expectancy of patients with SLE is reduced in comparison with that of an age-matched general population. The suggestion by some that a number of aspects of disease thought to carry a worse prognosis, notably renal disease, are amplified in men might suggest that mortality rates would be increased in men with SLE.
Interestingly among those studies that have addressed this outcome measure, the most consistent finding is that the overall mortality rates in men are comparable to those in women. Of the studies that have addressed mortality rates, four found no difference overall between male and female patients and three suggested an increase in mortality in male patients. Tan et al. showed that the mortality rate was significantly elevated in male lupus patients, with a mortality rate of 11.5% in comparison with 6.2% in the female cohort. Prete et al. also found an elevated mortality rate in males, but only within the first year after diagnosis. It should be highlighted that the latter study of the US veteran population included an older population, and the male cohort was significantly older than the female cohort. Specifically men had increased rates of myocardial infarction and neoplasia. Finally, Wang et al. reported higher rates of mortality in men with LN; however, this study had a small number of male subjects, which limits its power to detect a statistically relevant effect. The causes of death outlined in both these and other studies, which did not detect a difference by gender, included both SLE-specific and other causes. The low overall numbers do not permit a conclusive analysis of whether SLE-specific mortality is more associated with male gender and this needs to be addressed in prospective cohorts of greater duration.
Given the magnified cardiovascular risk recognized in SLE patients, it is an interesting variable to study as it may confer an increased risk over a longer time frame than may be captured within current studies. Many use the term cardiovascular disease as an all-embracing term to encompass a spectrum of disease from arterial hypertension to angina/myocardial infarction. A number of studies have shown that cardiovascular disease is amplified in men with SLE. In particular, in a few studies male gender has been associated with greater hypertension, angina, MI and even CVA in early disease. Whether this reflects the general enhanced cardiovascular risk in the male population or is further magnified by the inflammatory state of SLE in men is unknown.
Previous evidence also emphasizes the importance of capturing information on SLE-related damage as a prognostic indicator, with elevated damage scores associated with greater mortality. Of the many studies that have included information on damage, only one showed an association between male gender and damage at baseline, with a shorter time to accrual of further damage. Certainly the evidence from research to date is that despite the suggestion of greater frequencies of particular organ involvement in male subjects of certain ethnicities, this is not reflected in the limited information on mortality and morbidity captured by the SLICC index.
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