Review article:Systemic lupus erythematosis in Males

The paradigm of medical teaching in the medical training is that “SLE is a disease of females in the child bearing age group and the male to female ratio is 1:9”1. The present article is an attempt to compare the clinical profile of the rarer male SLE with female SLE which is more familiar clinical problem to a practicing physician.

Much of the data on the profile of male SLE comes from relatively small scale case series studies and the progile of oriental male sle patients is discussed in the present paper.

Why female SLE is commoner?
Estradiol binds to receptors on T and B lymphocytes, increasing activation and survival of these cells which are inappropriately activated by HLA and environmental factors as EBV to act hostile to autoantigens, thus favoring prolonged immune responses and prolonged tissue damages as in SLE. Testesterone was shown to have a protective effect the mechanism of which is poorly described in literature and needs further studies.

Differences in the clinical manifestations
Male SLE the commoner presentations are:
1. Pleurisy
2. Renal (kidney) disease(DPN Stage IV is commonest)
3. Thrombocytopenia
4. Seizures
5. Discoid lupus (reddish, scaly skin)
6. Subacute cutaneous lupus (skin lesions)
7. Hemolytic anemia (from the destruction of red blood cells)
8. Lupus anticoagulant (can promote abnormal blood clotting)
9. Drug-induced lupus erythematosus (DILE) due to greater incidence of diagnosis of systemic hypertension and arrythmia in males and its treatment with offending drugs.
10. Anti Ro Negativity which was statistically significant in many case series study.

Features common in female SLE
1. Neurologic (nervous system) symptoms
2. Alopecia (hair loss)
3. Thrombocytopenia (abnormal decrease in blood platelets)
4. Malar rash (rash on cheeks)Arthritis
5. Sjogren's syndrome (glandular damage that causes dryness of eyes and mouth)

Problems with Male SLE patients

Men with lupus face a unique challenge. It may be difficult for them to discuss a disease that so many people think occurs only in women. Because there are fewer men with systemic lupus, they may have trouble meeting other men with the disease. This may prevent them from gaining the benefits of mutual support. While many of female patients are interested in meeting any other people with SLE, virtually all of male patients ask about other men with whom they can speak.

References

1. Brauwnwald et al. “Principles of Internal Medicine 16th edition”;Tata McGrawhills publications.
2. Inman RD, Jovanovic L, Markenson JA, Longcope C,Dawood MY, Lockshin MD. Systemic lupus erythematosus in men: genetic and endocrine features. Arch Intern Med 1982;142:1813-5.
3. Steinberg AD, Melez KA, Raveche ES et al. Approach to the study of the role of sex hormones In autoimmunity. Arthritis Rheum 1979;22:1170-6.
4. Lahita RG. Sex steroids and the rheumatic diseases. Arthritis Rheum 1985^8:121-6.
5. Hazelton RA, McCruden AB, Sturrock RD, Stimson WH. Hormonal manipulation of the immune response in systemic lupus erythematosus: a drug trial of an anabolic steroid, 19-nortestosterone. Ann Rheum Dis 1983;42:155-7.
6. Lahita RG, Cheng CY, Monder C, Bardin CW. Experience with 19-nortestorone in the therapy of systemic lupus erythematosus: worsened disease after treatment with 19-nortestosterone in men and lack of improvement in women. / Rheumatol 1992;19:547-55.
7. Jungers P, Kuttenn F, Loite F et al. Hormonal modulation in systemic lupus erythematosus: preliminary clinical and hormonal results with cyproterone acetate. Arthritis Rheum 1985;28:1243-50.