Systemic lupus erythematosus, commonly known as lupus, is a chronic autoimmune disease where the body’s immune system mistakenly attacks its own healthy tissues and organs. While it is often associated with women, men can indeed develop this condition. Understanding that lupus affects men is important for timely diagnosis and management, as misconceptions can lead to delays in care.
Lupus in Men: Dispelling the Myth
Lupus is significantly more prevalent in women than in men, with women accounting for about 9 out of 10 cases. Despite this imbalance, men comprise a notable portion, ranging from 4% to 18%, of lupus patients. The onset of lupus in men often occurs later in life, with a mean age of around 40, which is about a decade later than the typical onset age for women.
The lower incidence of lupus in men is thought to be influenced by hormonal factors. Estrogen, which is more abundant in women, appears to contribute to the development and severity of lupus, as shown in animal studies. Conversely, testosterone, a male sex hormone, is believed to have an immune-suppressing effect that may dampen the disease’s impact. Research indicates that men with lupus may have lower testosterone activity at the cellular level, potentially increasing their risk of autoimmunity.
Distinct Presentation and Diagnosis
While many lupus symptoms overlap between sexes, the disease can manifest differently in men, posing unique challenges for diagnosis. Men with lupus may experience more severe symptoms and a higher likelihood of organ damage. For instance, kidney involvement, known as lupus nephritis, is often more common and severe in men, increasing their risk of kidney damage. Men may also have a higher incidence of seizures, heart problems, and inflammation of the lining around the lungs (pleurisy) or heart (pericarditis).
Diagnostic challenges often lead to delays for men with lupus. The perception that lupus is primarily a “women’s disease” can result in healthcare providers overlooking the diagnosis in male patients. This diagnostic bias can lead to a prolonged period before an accurate diagnosis is made, with studies indicating an average delay of two years or even longer. Such delays can result in more aggressive symptoms and increased organ damage.
Management and Living with Lupus
The general principles of lupus management apply to both men and women, focusing on controlling inflammation, preventing organ damage, and managing symptoms. Treatment approaches commonly involve medications such as anti-inflammatories, corticosteroids, antimalarials like hydroxychloroquine, and immunosuppressives. Hydroxychloroquine is considered a fundamental treatment for lupus, helping to reduce disease flares and overall damage over time.
Men living with lupus may encounter specific challenges beyond the physical symptoms. They can face psychological impacts, including depression and anxiety. Social stigma can also be a factor, as men might feel isolated due to the misconception that lupus is exclusively a female condition, making it difficult to find peer support. Furthermore, some lupus medications, such as cyclophosphamide and glucocorticoids, can affect male fertility by impacting sperm quality or hormone production. Open communication with healthcare providers about these concerns is important for tailored care and support.