Systemic lupus erythematosus is a very challenging disease. Although some features of lupus are common, such as joint pain and fatigue, lupus is different in every person. It is truly a disease that seemingly provokes more questions than it provides answers.

While the pathogenesis, or reasons for development, of lupus remains unknown; genetic, environmental, and hormonal factors certainly play a role. Most people think of lupus as a disease of women of childbearing age-and with good reason: 90% of lupus patients between the ages of 15 and 45 are women. However, after the age of 50 (approximately the age of the onset of menopause) the percentage of women with lupus falls to 75% and the percentage of men with the disease rises to 25%. Therefore it is a mistake to think of lupus as exclusively a women's health concern.

Role of Sex Hormones

The role of sex hormones in the development and clinical expression of lupus is complex. For instance, flares in women may be influenced by their hormonal status; one example is that pregnancy can trigger a flare.

Simply put, two broad types of sex hormones exist. Estrogens are typically considered the "female hormones," and androgens are considered to be the "male hormones." Both types are produced in both sexes. However, estrogens-in addition to their role in the development of secondary sex characteristics (i.e., facial hair in males or breast development in females)-may encourage autoimmune disorders, while androgens may be protective instead.

Some studies have noted lower levels of a specific androgen, testosterone, in some men with lupus. Men with lupus, however, are in no way less masculine than men without lupus, and sexual activity, potency, and fertility in men with lupus does not differ from men without lupus.

Clinical Similarities and Differences

Several studies have tried to characterize lupus in men, in particular searching for any clinical differences between men and women. The results of these studies are difficult to interpret for several reasons: the small number of male patients, differences in study methods, ethnic and racial differences that may influence the way lupus affects certain individuals. The accompanying table summarizes clinical differences found in some of the most frequently quoted studies. As you can see, the results are often conflicting.

Reported Clinical Differences in Men and Women Lupus Patients

Study	Features More Common in Men	Features More Common in Women
1. M.H. Miller, et. al.(1983)	Pleurisy (inflammation of the sac around the lungs)	Neurologic (nervous system) symptoms Alopecia (hair loss) Thrombocytopenia (abnormal decrease in blood platelets)
2. L.D. Kaufman, et. al. (1989)	Renal (kidney) disease Thrombocytopenia
3. M.M. Ward & S. Studenski (1990)	Renal failure Seizures
4. J. Font, et. al. (1992)	Discoid lupus (reddish, scaly skin) Subacute cutaneous lupus (skin lesions)	Malar rash (rash on cheeks) Arthritis
5. M. Petri (1997)	Hemolytic anemia (from the destruction of red blood cells) Lupus anticoagulant (can promote abnormal blood clotting) Seizures	Sjogren's syndrome (glandular damage that causes dryness of eyes and mouth)

A study by Dr. Michelle Petri from Johns Hopkins University tried to address the differences in men and women lupus patients by comparing the clinical and laboratory features of a group of 41 males and 545 females. She found that men had an increased frequency of seizures, immune-mediated anemia, and lupus anticoagulant (which may lead to clotting problems), but a lower frequency of Sjogren's disease. Her study suggests that men may have more severe disease than women.

Even though the percentages of certain symptoms may be different in men and women, the manifestations are very similar. For example, the arthritis of lupus, which typically affects the small joints of the hands and is associated with morning stiffness, is the same in men and women. And, while the frequency of discoid lupus erythematosus (DLE) may be more common in males, the characteristic flat, non-painful, scarring lesions look identical in both sexes. The same is true for the acute rashes (malar rash) and for subacute cutaneous lupus erythematosus (SCLE).

Drug-induced lupus erythematosus (DILE) illustrates the role of environmental triggers in the development of lupus. DILE is commonly associated with hydralazine, procainamide, and isoniazid, and is more common in men because the disorders for which some of these medications are used (e.g., high blood pressure, irregular heart rhythms) are diagnosed more often in men.

As our understanding of lupus increases, additional research is needed to identify subsets of people with lupus in order to improve the treatments and outcomes of those patients.

Coping With Lupus

Anyone, male or female, who has been diagnosed with lupus has experienced the frustration of uncertainty and the difficulty of learning the new language needed to understand this disease. Anxiety about the future as well as family and employment issues are common concerns.

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 our female patients are interested in meeting any other people with lupus, virtually all of our male patients ask about other men with whom they can speak.

Current research may provide new insights into the immune system and the role that genetic and hormonal factors play in autoimmune diseases. Variables related to gender may help unravel the mysteries of lupus, but it is impossible to predict a person's progress based on gender alone. And, it is important to remember that the management of lupus is tailored to the clinical manifestations of each individual.

On this Website:

Lupus and Men

On the Web:

Men's Health Issues (NIH)