Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
Department of Clinical and Experimental Medicine and Department of Mathematics, University of Pisa, Pisa, Italy.
Lupus Sci Med. 2023 Apr;10(1). doi: 10.1136/lupus-2022-000880.
SLE is an autoimmune disease that predominantly affects women. As most epidemiological and interventional studies are on populations with a clear female prevalence, the influence of gender in disease course, drug response and damage accrual is yet to be fully explored and comprehended.
To describe gender differences in disease course, comorbidities, use of medications and long-term outcomes of a large cohort of patients with SLE.
Retrospective gender-based analysis of prospectively collected data from a monocentric cohort of Caucasian patients with SLE with at least 1 year of follow-up.
417 patients were included, 51 men and 366 women. Men displayed a significantly higher median age at disease onset and diagnosis and a higher prevalence of late-onset SLE, serositis at disease onset, antiphospholipid syndrome (APS) and use of mycophenolate within the first year of disease. Women had a higher prevalence of haematological abnormalities, a higher cumulative exposure to azathioprine and higher cumulative dose of glucocorticoids at 5 years. Male patients had a shorter time to first damage item and a higher prevalence of damage at 1 and 5 years, but this association was no longer significant when late-onset patients were excluded. No differences were found in prevalence of childhood onset, delay between onset and diagnosis, time to renal involvement and histology, cumulative autoantibody positivity, number of flares and hospitalisations, median SLE Damage Index score, type of damage, age and time to first cardiovascular event, chronic kidney disease and death.
In our cohort, clinical manifestations and disease course were similar in male and female patients; however, male patients displayed higher prevalence of APS and early damage accrual probably due to the later disease onset. These data highlight the importance of an intensive follow-up, prevention and treatment of complications in this category of patients, especially in the first years of disease.
SLE 是一种主要影响女性的自身免疫性疾病。由于大多数流行病学和干预研究都是针对具有明显女性患病率的人群进行的，因此性别对疾病过程、药物反应和损害积累的影响尚未得到充分探索和理解。
描述大样本 SLE 患者人群中疾病过程、合并症、药物使用和长期结局的性别差异。
对来自单中心队列的、至少有 1 年随访的白种人 SLE 患者前瞻性收集数据进行回顾性性别分析。
共纳入 417 例患者，其中男性 51 例，女性 366 例。男性发病和诊断的中位年龄明显较高，且晚发性 SLE、发病时的浆膜炎、抗磷脂综合征（APS）和疾病发病后 1 年内使用霉酚酸的发生率较高。女性血液学异常的发生率较高，5 年内接受硫唑嘌呤累积暴露和糖皮质激素累积剂量更高。男性患者首次出现损害项目的时间更短，1 年和 5 年时的损害发生率更高，但排除晚发性患者后，这种相关性不再显著。两组在儿童发病、发病至诊断的时间延迟、发生肾损害和组织学的时间、累积自身抗体阳性、 flares 和住院次数、SLE 损害指数评分中位数、损害类型、年龄和首次心血管事件、慢性肾脏病和死亡的时间上无差异。
在我们的队列中，男性和女性患者的临床表现和疾病过程相似；然而，男性患者 APS 发生率较高，且早期损害积累更多，可能是由于发病较晚。这些数据突出了对这一人群进行强化随访、预防和治疗并发症的重要性，尤其是在疾病的最初几年。
