Lupus is an autoimmune disease affecting 1.5 million people in the United States and can cause potentially serious health complications such as kidney disease and stroke. Contrary to popular belief, lupus does not exclusively affect women; it can also occur in men.
This article explores the occurrence of lupus in men, addressing the unique diagnostic challenges they face. Despite being much less prevalent in men, lupus in males often results in more severe disease progression and delayed diagnosis, underscoring the need for heightened awareness and improved diagnostic approaches to ensure timely and effective treatment.
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What Is Lupus?
Autoimmune diseases are conditions where the immune system mistakenly recognizes healthy tissues as foreign, provoking an attack on the body's own cells.Β
Lupus can affect many different systems within the body. It causes chronic inflammation that targets the skin, joints, kidneys, and other organs, resulting in potentially severe health complications.Β
Most cases of lupus are multisystemic, affecting multiple organs and systems. This form of lupus, systemic lupus erythematosus (SLE), accounts for 70% of cases of lupus and affects 3.4 million people worldwide. Other forms of lupus include:
- Cutaneous lupus erythematosus: This form of lupus is limited to the skin and can cause rashes worsened by sun exposure.Β
- Drug-induced lupus erythematosus: This condition presents with similar symptoms to SLE but is caused by certain medications such as procainamide and hydralazine. It accounts for 6-12% of all lupus cases and usually spares the kidneys, lungs, and nervous system.Β
- Neonatal lupus: This form is caused by the transfer of lupus autoantibodies from mother to fetus.Β Β
Symptoms of Lupus
Like many other autoimmune diseases, the symptoms of lupus can wax and wane, creating periods when they are severe and periods when they are mild or unnoticeable. This can make diagnosis difficult, especially as lupus can affect many different systems and thus mimic other conditions such as Lyme disease and fibromyalgia.Β
Common symptoms of lupus include:
- Joint pain and stiffness
- Unexplained fevers
- A malar rash which presents as a butterfly-shaped rash across the nose and cheeks
- Other rashes that are worsened with sun exposure
- Fatigue
- Hair loss
- Painless sores in the nose and mouth
- Raynaud's phenomenon
- Headaches
- Swelling of the joints, lower legs, or around the eyes
- Swollen glands
- Abdominal pain
- Weight loss
Accurate and swift diagnosis is crucial as lupus can result in potentially serious complications if not treated or poorly controlled. These include:
- Lupus nephritis is when the kidneys become damaged, impairing kidney function.
- Inflammation of the heart muscle or the tissue that surrounds the heart
- Blood clots
- Inflammation of the blood vessels
- Anemia
- Pleurisy is a condition marked by inflammation in the tissue that encases the lungs, causing painful breathing.
- Seizures, due to central nervous system effects
Lupus Risk Factors
Although the causes of lupus are not yet fully understood, there appear to be risk factors associated with developing this disease. These include:
- Being a woman of childbearing age: Lupus predominantly affects women with a ratio of 10 to 1 compared to men and develops most often between the ages of 15-44 years old.Β
- Genetics: Occurrence is more likely if a close family member has lupus or other autoimmune disease.Β
- Ethnicity: In the US, a higher prevalence of lupus occurs in African Americans, Hispanic Americans, Asian Americans, and Native Americans compared to Caucasian Americans.Β
- Hormones: Although the extent to which hormones influence the development of lupus is unclear, sex hormones such as estradiol, progesterone, testosterone, and DHEA have been shown to affect the activity of SLE.Β
Lupus Myths & Gender Misconceptions
Lupus is not widely known or understood by the general population. A global survey reported common misconceptions about this condition, including:
- 36% did not realize that lupus is a disease
- Over 50% did not know that lupus can potentially result in severe conditions such as kidney failure and heart attack.Β
- Over one-third of participants thought that lupus was contagious and were unwilling to sit next to or share food with someone with the disease.Β
- That lupus only affects women and that men are unable to contract the disease.
These misconceptions can be harmful, as they may result in social stigmatization and an overall lack of awareness that may prevent affected individuals from seeking help and necessary treatment.Β
Can Men Get Lupus?
Although it is true that lupus most commonly occurs in women, 1 in 10 cases affects men. The false impression that lupus only affects women can result in misdiagnosis or delays in diagnosis, resulting in postponed treatment and more severe progression of the disease.Β
Unique Aspects of Lupus in Men
For the most part, the clinical features of lupus in men overlap with those in women, though there are a few key differences, one of which is the severity of the disease. Men with lupus appear to experience more frequent relapses than women, and older men tend to have higher mortality rates than women.Β
Additionally, the age of diagnosis is often delayed in men compared to women. While peak diagnosis occurs between 20-30 years of age for women, men are usually not diagnosed until the age of 45-60. This may be partially attributed to the difficulty in obtaining an accurate and timely diagnosis due to physicians overlooking the possibility of lupus in men.Β
Challenges in Diagnosing Lupus in Men
Because of the high prevalence of lupus in women, many of the clinical studies that describe clinical features and the progression of the disease do not include men. This makes it difficult to understand how lupus affects men differently and often precludes lupus as a potential diagnosis in men presenting with symptoms.Β
In lupus studies that include men, results are often conflicting, with some studies reporting no difference in organ involvement and symptoms between men and women. In contrast, others report an increased incidence of seizures and pleurisy in men.Β
More studies are clearly needed to help build clinical awareness and understanding of lupus in men and ensure quicker diagnosis and treatment efficacy.Β
Common Signs and Symptoms of Lupus in Men
For the most part, the symptoms of lupus are similar to those in women. Systemic symptoms such as fatigue, headache, fever, and weight loss are the most common. However, emerging evidence suggests differences in specific clinical manifestations in men compared to women. These include:
- Less joint pain and fibromyalgia-like symptoms
- Higher occurrence of pain, numbness, tingling, and weakness in the hands and feet
- Higher rates of vasculitis (inflammation of the blood vessels)
- Lupus anticoagulants, which are antibodies that increase the risk of blood clots, are more commonΒ
- Hair loss is less frequent
- Lower rates of malar rash
- Pleurisy is more likelyΒ
- Cardiac complications are more common
- Seizures are more common, though other central nervous system complications are not
Individuals who present with any of the symptoms of lupus must be evaluated immediately by a healthcare professional, as prompt diagnosis can lead to a quicker onset of treatment and delay progression into more severe manifestations.Β
Lab Testing for Lupus
Accurate diagnosis of lupus requires comprehensive lab testing. The most common lab tests run for the initial diagnosis of lupus include:
- Antinuclear antibodies (ANA) screen: ANA levels are consistently elevated in the presence of lupus and are often the first test run. Because ANA levels can also be elevated in the presence of other autoimmune diseases, this test is not specific to lupus and cannot be used alone for diagnosis.Β
- Anti-ds DNA, anti-Smith, and antiphospholipid antibodies: These antibodies are more specific for lupus and can help confirm a diagnosis when an ANA screen is positive. The levels of these antibodies can also help indicate disease severity.Β
- Complement C3: Low levels of complement 3 are linked to increased disease activity and risk of kidney complications.Β
Additional Tests and Assessments
Once lupus is diagnosed, other tests may be run to check for organ involvement and disease progression. These include:
- Complete Blood Count (CBC): Assesses for anemia, elevated platelets, and immune system dysfunction.
- Comprehensive Metabolic Panel (CMP): Evaluates for potential liver and kidney function issues.
- Erythrocyte Sedimentation Rate (ESR or sed rate) and C-reactive protein (CRP): Inflammatory markers that can help indicate disease activity.
- Biopsies: Small samples of tissues may be collected from affected organs. For example, kidney biopsies help to check for kidney damage and lupus nephritis, and biopsies of skin rashes can help confirm a lupus diagnosis.Β
- Urine samples: To assess for signs of kidney involvement, such as elevated protein levels.Β
It is important to note that the diagnosis and assessment of lupus are not based on labs alone. They should also include a comprehensive physical exam and an in-depth review of patient history and symptoms to better evaluate organ system involvement and the severity of the disease.Β
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Key Takeaways
- Though less common, lupus can affect men, often resulting in more severe symptoms and delayed diagnosis compared to women.
- Increasing awareness of lupus in men is crucial to combat misconceptions and ensure timely diagnosis.
- Accurate diagnosis requires comprehensive lab testing and medical evaluation to identify lupus and assess disease severity.
- Early diagnosis and treatment are vital to prevent serious health complications and improve outcomes for men with lupus.
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