Lupus and Gender
By A. G. Moore
Most of us know that lupus affects females more commonly than it does males. The ratio most often reported is 1 to 9. For every male that has lupus there are supposed to be about nine females (See: Men and Lupus http://www.lupus.org/webmodules/webarticlesnet/templates/new_aboutindividualized.aspx?articleid=109&zoneid=18). Generally, it has been considered that lupus in males and females is much the same disease. However, when it comes to lupus, nothing can be taken for granted. In a recent article published in Clinical and Developmental Immunology, Julie Schwartzman-Morris and Chaim Putterman, of the Albert Einstein College of Medicine, explore the question of male vs female occurrence in SLE. Their findings were based on cross-cultural and cross-national studies and indicate a possibly clinically significant difference in the way lupus affects females and males.
The Morris/Putterman article considers studies in diverse populations, including those in China, Latin America, Greece and the U.S. The findings almost uniformly indicate a more severe course of illness for males than for females (except for one contradictory study in Hong Kong). This less favorable outcome for males was linked, in most cases, to an increase in the incidence and severity of lupus nephritis.
There were other differences detected between males and females who had lupus. One of the differences was that it took less time for a male to be diagnosed with the disease than for a female to be diagnosed. Another difference was that males seemed to experience more seizures than females but reported less arthralgia.
Whenever a well-sourced, responsible study is released–and the Morris/Putterman paper is responsible in the extreme—caution should be exercised in its interpretation. In considering gender differences and healthcare,there may be issues of reporting and physician interpretation.
Speedier diagnosis, for example could be due to the fact that many doctors are more likely to take seriously a man reporting symptoms than a woman reporting symptoms (see: http://www.ncbi.nlm.nih.gov/pubmed/22457480 and http://www.un.org/womenwatch/daw/csw/healthaide.htm). Also influencing the speed of diagnosis could be the fact that, if indeed males experience higher incidence of lupus nephritis, then this symptom would likely lead to earlier diagnosis—since nephritis is almost a hallmark symptom of systemic lupus.
The implications of a possible gender difference in lupus manifestation are significant. It has been suggested that drug protocols might be established that target the particular susceptibility of male patients to severe lupus nephritis. Also, an awareness on the part of physicians and patients that this risk seems to exist, would suggest a more vigilant approach toward monitoring kidney function in male lupus patients.