title: Systemic lupus erythematosus in Spanish males: a study of the Spanish Rheumatology Society Lupus Registry (RELESSER) cohort.
abstract: Objective The objective of this study was to describe the demographic, clinical, and immunological manifestations of systemic lupus erythematosus (SLE) in male patients. Methods A cross-sectional, multicenter study was carried out of 3651 patients (353 men, 9.7%, and 3298 women, 90.2%) diagnosed with SLE, included in the Spanish Rheumatology Society SLE Registry (RELESSER). Results Mean ages (18-92 years) of symptom onset were 37 (SD 17) years (men) and 32 (SD 14) years (women). Male/female ratio was 1/9. Age of onset of symptoms and age at diagnosis were higher in men than in women ( p < 0.001). Males were diagnosed earlier than females (p = 0.04) and had more cardiovascular comorbidities ( p < 0.001). Two hundred and thirty-six males (68%) with SLE required hospitalization in comparison with 1713 females (53%) ( p < 0.001). During follow-up, 208 patients died: 30 men (9.3%) and 178 women (5.9%) ( p = 0.02). As regards clinical manifestations, loss of weight ( p = 0.01), lymphadenopathies ( p = 0.02), and splenomegaly ( p = 0.02) were more common in male patients. Female patients were more likely to have inflammatory rash, alopecia, and arthritis ( p < 0.05). As for lung involvement, men with SLE had more pleural fibrosis ( p < 0.001) and pulmonary embolism ( p = 0.01). However, Raynaud's phenomenon was more common in women (35%) than in men (23.7%) ( p < 0.001); lupus nephritis was more common in men, being present in 155 (44.8%) of males versus 933 (29%) of females ( p < 0.001). Multivariate analysis showed that SLE patients with a high Charlson index (more than 3 points) and age > 50 years had a higher mortality (odds ratios 3.6 and 2.1, respectively). Furthermore, SLE patients who developed pulmonary hemorrhage, pulmonary hypertension, psychiatric involvement, complement deficiency, and hemophagocytic syndrome also had higher mortality, regardless of gender. Conclusion Patients with SLE over the age of 50 years have an increased risk of mortality. In Caucasians, age at diagnosis and symptom onset is higher in men than in women. The diagnostic delay is shorter in men. Male SLE patients present more cardiovascular comorbidities, and also more serositis, adenopathies, splenomegaly, renal involvement, convulsion, thrombosis, and lupus anticoagulant positivity than women.
authors: 1 Rheumatology Department, Germans Trias i Pujol University Hospital, Badalona, Spain.|2 Medicine Department, UAB, Spain.
authors: A
authors: A
authors: Riveros Frutos
authors: 3 Preventive Department, Germans Trias i Pujol University Hospital, Badalona, Spain.
authors: I
authors: I
authors: Casas
authors: 4 Rheumatology Department, Doctor Negrín University Hospital of Gran Canaria, Las Palmas de Gran Canaria, Spain.
authors: I
authors: I
authors: Rúa-Figueroa
authors: 5 Rheumatology Department, Gregorio Marañón University Hospital, Madrid, Spain.
authors: F J
authors: FJ
authors: López-Longo
authors: 6 Rheumatology Department, Sierrallana Hospital, Torrelavega, Spain.
authors: J
authors: J
authors: Calvo-Alén
authors: 7 Rheumatology Department, Doce de Octubre University Hospital, Madrid, Spain.
authors: M
authors: M
authors: Galindo
authors: 8 Rheumatology Department, Carlos Haya University Hospital, Málaga, Spain.
authors: A
authors: A
authors: Fernández-Nebro
authors: 9 Rheumatology Department, University Hospital Complex Instituto de Investigación Biomédica de Vigo (IBIV), Spain.
authors: J M
authors: JM
authors: Pego-Reigosa
authors: 1 Rheumatology Department, Germans Trias i Pujol University Hospital, Badalona, Spain.
authors: A
authors: A
authors: Olivé Marqués
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D008181:Lupus Nephritis / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011928:Raynaud Disease / Q000453:epidemiology*; D012042:Registries; D012189:Retrospective Studies; D012737:Sex Factors; D013030:Spain; D055815:Young Adult
keywords: comorbidities; male patients; systemic lupus erythematosus