Is lupus common in males?

Male Lupus: Prevalence and Characteristics

No, lupus is not common in males, with males representing only about 4-22% of all systemic lupus erythematosus (SLE) patients, while approximately 90% of people with SLE are female. 1, 2

Epidemiology of Male Lupus

Male lupus is relatively rare compared to female lupus:

• The estimated prevalence in adult females is up to 3%, compared to only 0.07% in males 3
• According to recent comprehensive reviews, approximately 90% of people diagnosed with SLE are female 1
• The male-to-female ratio ranges from 1:4 to 1:22, depending on the population studied 2

Clinical Presentation Differences

While less common, male lupus often presents with some distinct characteristics:

• Disease Severity: Male patients often have more severe disease than females 4, 5

• Organ Involvement:

  • Males have higher rates of renal involvement (lupus nephritis) 4
  • Cardiovascular complications are more common in males and represent the most common cause of death 6, 5
  • Males are at higher risk for progression to renal failure 4

• Clinical Features: Females are more likely to present with:

  • Oral ulcers (29.2% in females vs. 13.3% in males) 6
  • Urinary tract infections, hypothyroidism, depression, esophageal reflux, asthma, and fibromyalgia 5

Pathophysiological Differences

The gender disparity in lupus prevalence has been attributed to several factors:

• Hormonal Influences: Sex hormones play a significant role in immune regulation

  • Estrogen can enhance autoimmune responses
  • Testosterone may have immunosuppressive effects

• Genetic Factors: X-chromosome inactivation and genetic polymorphisms may contribute to the female predominance 2

Diagnostic and Treatment Considerations

The diagnostic approach for lupus is the same regardless of gender:

• The 2019 European Alliance of Associations for Rheumatology/American College of Rheumatology classification criteria are highly sensitive (96.1%) and specific (93.4%) for SLE 1

• Treatment is generally similar for both genders:

  • Hydroxychloroquine is the cornerstone medication for all lupus patients regardless of gender 7, 1
  • Additional immunosuppressive agents are individualized based on disease severity and organ involvement
  • Recently approved medications include belimumab, voclosporin, and anifrolumab 1

Clinical Implications

Healthcare providers should be aware that:

• Although less common in males, lupus should still be considered in the differential diagnosis when appropriate symptoms are present
• Male patients may require more aggressive monitoring for renal and cardiovascular complications
• Disease activity monitoring should include regular assessment of complete blood count, anti-dsDNA antibodies, complement levels, serum creatinine, urinalysis, and urine protein/creatinine ratio 7

While lupus is predominantly a female disease, recognizing its presentation in males is important for timely diagnosis and appropriate management, particularly given the potential for more severe disease manifestations in this population.