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Background: Systemic lupus erythematous is a chronic autoimmune disease of unknown etiology. It predominantly presents in women of child-bearing age. The limited research available suggests that men with lupus are diagnosed at an older age compared to women, have a greater burden of end organ disease and a higher mortality. Objectives: To examine the clinical pattern in male lupus patients in a tertiary multi-ethnic lupus centre in East London. Methods: Male lupus patients were identified through review of a pre-existing database of lupus patients and lupus clinic lists at Barts Trust. All patients' electronic notes were reviewed prior to a telephone interview. All the participants fulfilled the ACR 1997 criteria for SLE. Descriptive data analysis was performed for all identified patients. Results: Fifty-one patients were identified. Sample demographics showed that male lupus was more prevalent among Afro-Caribbeans (37%,n=19), followed by Asians (33%,n=17) and then Caucasians (29%,n=15). The median age was 40.5(IQR: 32.5–52.7) years, with the median age at SLE diagnosis 28 years (IQR:23–45). Family history of an AI condition was seen in 25%(n=13), whilst 14%(n=7) had a family history specifically of SLE. Possible etiological triggers prior to diagnosis included a significant stressor such as death or illness of a loved one, financial challenges, marital separation, or challenges during childhood (childcare disruption or negligence) reported in 45%(n=23) patients. Serological evidence of previous infection with EBV, CMV, VZV, parvovirus, or H pylori was found in 76%(n=22). Although all patients were below the state pension age of 66, more than half (53%,n=27) were unemployed. 43%,(n=22) of participants had a smoking history. The majority of males had multiorgan involvement including renal (67%,n=34), cutaneous (55%,n=28), hematological (45%,n=23), musculoskeletal (31%,n=16), cardiac (27%,n=14), pulmonary (20%,n=10), and neurologic or neuropsychiatric (14%,n=7). Renal biopsy was done in 33/34 renal cases and the showed proliferative-class-III/IV in 65%(n=22). Hypertension was a significant comorbidity in 39%(n=20), 47%(n=24) had a concomitant AI condition (autoimmune hepatitis, rheumatoid arthritis, ITP, Evans syndrome, polymyositis, dermatomyositis, anti-synthetase syndrome or APS. Juvenile-onset SLE was diagnosed in 6%(n=3) of the patients. The median age of this group at disease onset was 10 years (IQR:14–16,100% Caucasians). These males all had kidney involvement (nephropathy class-IV/V). Regarding serology, 48 (94%) were positive for ANA at 1:640(44/48) and 1:160(4/48). In 2 patients ANA test was not recorded but they had confirmed renal or cutaneous biopsy findings. Of the 48 ANA positive samples, 19(40%) speckled, 15(31%) homogenous, 4(8%) each for nucleolar and mixed pattern and 6(13%) were not identified. Three quarters (75%,n=38) were positive for ds-DNA. Ro and La antigens were detected in 35%(n=18) and 8%(n=4) of the patients respectively, while anti-Sm and anti-U1RNP were detected in 37%(n=19) and 43%(n=22), respectively. Antiphospholipid antibodies were identified in less than a third(29%,n=15), of which 40%(n=6) presented with thrombotic events, including deep vein thrombosis, pulmonary embolism, stroke or myocardial infarction. Triple antiphospholipid antibodies including aCL, LA, and anti-B2GP1 was detected in 53%(8/15), 20%(3/15) had LA, 15%(2/15) had aCL, and 7%(1/15) had either anti-B2GP1 or aCL/anti-B2GP. Conclusion: SLE has a low prevalence in males, leading to a paucity of data in this cohort. Our dataset demonstrates a higher prevalence in Afro-Caribbean and Asians compared to Caucasians and a young age of onset (median 28 years) with presentation about 10 years earlier than most other reports. The majority were unemployed and reported significant life stressors. Over three-quarters of the patients had evidence of prior infection with herpes virus or parvovirus. Most of the lupus males had multiorgan involvement and over two-thirds had renal involvement, proliferative class-III/IV. There was a high prevalence of dsDNA (75%), ENA (particularly anti-Ro (35%)) and APL (29%). REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests: None declared.
Aldeyarbi et al. (Sat,) studied this question.