Systemic Lupus in Men : What feature?

      Lupus is rare in men depending on series. There seems to have in men more kidney damage but this is controversial. There also seems to have more neurological manifestations, thrombotic manifestations, cardiovascular, serositis, arthritis, hepatomegaly, infections .... but this is very variable from one series to another.

    Tan and coll.  relate datas from a series of 1979 patients from Hopkins Lupus Cohort. From this cohort were extracted 157 men (66,2% white men, 33,8% African Americans men). They were compared to 1822 women (59,8% white women and 40,2% African Americans women). The mean follow-up was of 6,02 years (extremes : 0 to 23,73 years). After adjusting for ethnicity, smoking history, age of last evaluation and development of lupus duration, men appear older at diagnosis (30 year in 67,3% of cases versus 48,9% of cases), men have a lower educational level, and they have less often malar rash (39,7% versus 52,4%), less photosensitivity (40,4% vs 55,5%), less mouth ulcers (34% vs 52,9%), less frequently  alopecia, Raynaud phenomenon and arthralgia.

    If anticardiolipine antibodies were found in both sexes in about 50% of cases, the presence of a lupus anticoagulant is more common in men (41.3% vs 55.5%). A higher incidence of deep venous thrombosis is also reported in men. Men also had more often renal failure (34,1% vs 18,9%).

   The authors conclude that there are differences in the clinical expression of lupus in men compared to women

PR Eric HACHULLA CHRU ("RUHC" :  Regional University Hospital Center), Lille.