Lupus
Lupus in Men
Michelle Petri, M.D.
Professor of Medicine
Division of Rheumatology
John Hopkins School of Medicine, Balt Lupus isn‘t supposed to happen in men. In mice, testosterone protects against the development of lupus, Yet 10 percent of lupus patients are male. The men with lupus who come to our Lupus Center must feel alone and out of place, surrounded as they are by women and carrying the stigma of having a “female disease.” Most men with lupus have normal levels of testosterone, although research studies suggest that men with lupus may have an imbalance ratios of androgen and estrogen, two other important hormones.
It is not just that lupus is less common inmen. Lupus is different in men. The men with lupus in our Lupus Center participate in the Hopkins Lupus Cohort, a prospective study of
the natural history of lupus. The fifteen-year follow-up data available allow us to describe the natural history of lupus in men in great detail. Men with lupus differ from women in the frequency of various organ manifestations. Men are more likely to have hemolytic anemia (low red-blood-cell counts from destruction of red blood cells by lupus antibodies) and seizures. imore, MD Men are less likely to have Sjogren’s syndrome (dry eye/dry mouth) and alopecia (hair loss). Men with lupus also differ in some of the lupus laboratory findings. Males are more likely to have low levels of C3, an immune system protein. Men with lupus have the lupus anticoagulant, an antiphospholipid antibody that increases the risk of blood clots, almost twice as often as women.
Additionally, men are more likely than women to test positively for an antibody that leads to hemolytic anemia. Our longitudinal data show that men with lupus have fewer flare-ups than women. This makes sense, since testosterone in mice models of lupus helps to keep lupus “quiet,” whereas estrogen “activates” lupus. In spite of this, our male patients with lupus are more likely to be permanently damaged in one or more organ systems than women.
We have also found that men differ from women in the specific types of organ damage that occur. Men are more likely to develop pulmonary fibrosis (lung scarring). Men also have a much higher frequency of hypertension. This may be one reason why men are more likely to develop renal insufficiency (loss of kidney function), because hypertension is known to accelerate kidney damage. Men with lupus develop more thrombosis (blood clots) and myocardial infarctions, or heart attacks. The fact that men have more lupus anticoagulant positivity likely contributes to this thrombosis damage. Finally, men are more likely to develop glaucoma.
The differences in male and female lupus have not been adequately studied or explained. However, the data suggest that physicians should monitor men with lupus carefully for risks for thrombosis, lung fibrosis, and renal insufficiency. The increase in damage found in men with lupus means that they are more likely to be disabled by the disease than women are. The societal stereotype of the male as the “strong provider” may put men with lupus at additional stress. Understanding that male and female lupus have important differences will help physicians who treat the disease to offer appropriate medical care and emotional support to men with lupus.