Systemic lupus erythematosus, commonly known as lupus, is a chronic autoimmune disease. The body’s immune system mistakenly attacks its own healthy tissues and organs, leading to widespread inflammation and potential damage in various parts of the body, including the skin, joints, kidneys, heart, and lungs. While often associated with women, lupus can affect anyone.
Lupus in Men: Prevalence and Underlying Factors
Lupus is considerably less common in men than in women. Approximately 1 in 10 individuals diagnosed with lupus are male. The male-to-female ratio varies with age: men account for about one in four cases in children and early adolescents, 6% to 10% of cases between ages 15 and 50, and about one in nine new diagnoses after age 50.
This disparity is thought to stem from biological factors, including hormonal differences, genetic predispositions, and variations in immune response. Estrogen, a hormone present in higher levels in women, is believed to encourage autoimmune disorders and can affect immune system activity. Research indicates estrogen may abnormally activate the immune system, potentially leading to the attack on healthy cells that characterizes autoimmunity.
Genetic factors, particularly those involving the X chromosome, also contribute to the sex bias. Females typically have two X chromosomes, while males have one. The X chromosome carries numerous immune-related genes, and differences in their expression or regulation can influence autoimmune susceptibility. For instance, men with Klinefelter syndrome (XXY), who have an extra X chromosome, have a significantly higher risk of developing lupus compared to men with a single X chromosome. This suggests the presence and activity of genes on the X chromosome play a role in disease development.
Clinical Manifestations in Men
While many lupus symptoms overlap between sexes, some manifestations may present differently or with varying severity in men. Common symptoms include extreme fatigue, joint pain, and skin rashes. The classic “butterfly rash” across the cheeks and nose may be less common or recognized in men. Other skin issues, such as discoid lupus (red, scaly, often circular rashes), might be more prevalent.
Men with lupus tend to experience more severe disease manifestations, particularly involving internal organs. Kidney involvement, known as lupus nephritis, is often more severe in male patients. Other frequently affected organ systems include the heart, lungs, and blood. Men may experience inflammation of the lining around the lungs (pleurisy) or heart (pericarditis), and a higher incidence of cardiovascular complications. Neurological issues, low blood counts (anemia, low white blood cells, low platelets), and the presence of lupus anticoagulant (which increases blood clot risk) are also more common or severe in men.
Diagnostic Challenges and Management Approaches
Diagnosing lupus in men can present unique challenges, often leading to delays compared to women. The lower prevalence and the misconception that it is primarily a “women’s disease” can lead healthcare providers to initially overlook lupus. This delayed diagnosis means men may be older at diagnosis, sometimes around age 40, about a decade later than the typical diagnosis age for women. Consequently, men may experience more advanced disease progression and organ damage by the time lupus is identified.
The diagnostic process involves clinical criteria and laboratory tests. Doctors look for a range of symptoms and may order blood tests such as antinuclear antibody (ANA) tests, anti-double-stranded DNA (anti-dsDNA) antibodies, and complement levels. These tests help detect specific autoantibodies and assess immune system activity. Due to the potential for more severe organ involvement, a thorough evaluation of kidney function, blood counts, and other organ systems is important.
Management strategies for lupus are generally similar for both sexes, focusing on controlling symptoms, preventing disease flares, and minimizing organ damage. Treatment plans are tailored to the individual’s specific symptoms and disease severity. Common medications include nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and swelling, corticosteroids to reduce inflammation, and immunosuppressive agents to modulate the immune system. Antimalarial drugs, such as hydroxychloroquine, are also frequently used to manage symptoms and slow disease progression. A multidisciplinary approach involving various specialists is often employed to address the diverse ways lupus can affect the body.