Men and Lupus

Systemic lupus erythematosus (SLE), or lupus, is far more common in women (affecting approximately nine women for every man) but men do get lupus. Most women are diagnosed with lupus during childbearing years, but for men the onset of symptoms may occur at any age including childhood.

During puberty, about 25 per cent of people diagnosed with lupus are young men, and in later years, about 20 to 40 per cent of the newly diagnosed lupus patients are men. There are an estimated number of about 5,000 men living with lupus in Canada. Systemic lupus in men can present similarly to lupus in women. This can include skin rashes, pleurisy, fatigue, neurological illnesses such as peripheral neuropathy (inflammation of the nerves in the arms and legs), joint pain, kidney disease, Raynaud’s phenomenon and vasculitis (inflammation of the blood vessels).

Discoid lupus erythematosus (DLE), which is non-systemic, involves localized skin rashes (coin-shaped scaly lesions generally found on the scalp, face, cheeks and nose). DLE is usually painless, but for some may be quite painful. Patients with DLE may be very photosensitive, and need to limit their sun exposure to reduce lesions and possible scarring.

Drug-induced lupus (DILE) Drug-induced lupus is the result of certain medications that cause lupus symptoms such as joint pain, muscle pain, fever, arthritis and inflammation of the heart and lung. These symptoms can be mild, moderate, or severe. More men develop DILE than women, probably because more men seem to be prescribed medications that produce DILE. The most common drugs that result in drug-induced lupus include medications for heart disease, and high blood pressure. After discontinuing the medication, lupus symptoms gradually disappear, but this may take many days, months or longer to disappear.

Diagnosing men with lupus

In order to diagnose lupus there needs to be comprehensive history and physical examination and investigations, such as blood tests. The American College of Rheumatology for research purposes had identified 11 diagnostic criteria some of which pertain to findings in the skin, blood, joints and organs. The presence of at least four of the criteria indicates a diagnosis of SLE by this standard. However, it is possible for a rheumatologist to confirm an SLE diagnosis in some patients, even if the patient does not meet ACR research criteria. Common manifestations include rash, oral ulcers, and inflammatory arthritis. There are other organs that can be involved including the kidneys, lungs and brain.

Hormones and SLE It has long been thought that hormones may play a role in the prevalence of lupus in both men and women. Studies have found that:

1. Young men with lupus have been found to have normal levels of Testosterone (a male hormone), however there is some evidence that lower levels of testosterone in both young and older men may predispose these men to autoimmune-like diseases
2. There is no increase of estrogen (a female hormone) in men with lupus. More research is being done on the hormone androgen. It has been found that women with lupus metabolize androgen at a faster rate than women without lupus, and thus have a lower amount of this hormone in their body. This is of interest, as androgens have been shown to have some immunosuppressive properties. As well, researchers want to find out if androgens explain the lower number of men having lupus compared to women.

Why do some men get lupus?

It is unclear why men get lupus, but it appears that in some animal studies on lupus, both men and women who have lower active testosterone levels at the cellular level may have an increased risk of autoimmunity or a lupus flare. Lupus may be caused by a combination of genetic predisposition with certain variables, such as a viral illness or stress or other factors that might stimulate your immune system to trigger an autoimmune reaction.

Will my children be at risk of lupus if I am a male with lupus?

Lupus rarely runs in families. Lupus occurs in about 1 in 2,000 people in the general population. In families of lupus patients there is an increased risk of lupus, rheumatoid arthritis, scleroderma, juvenile arthritis and polymyositis. However, this risk might only be 1 to 5 per cent which is higher than the risk for the general population, but not as strong a risk as that seen with genetic illnesses, which often have a 25 to 50 per cent risk. Therefore, men with lupus who would like to have children should not let lupus change their minds. Speak to your physician if you have other concerns regarding your health or how medications you may be taking could have an impact on your ability to be a parent.

Are there special treatments that men with lupus should have?

Men and women with lupus are treated in similar ways. Your physician will treat the signs and symptoms and monitor organ involvement and the severity of the lupus. Treatments may include anti-inflammatory medications for the joints and antimalarial drugs for skin and joints. Immunosuppressive medications are usually reserved for significant internal organ involvement or sometimes in severe joint involvement.