Clinical profile of lupus erythematosus in Nigerian males

Abstract

Background: Systemic Lupus Erythematosus (SLE) is a sexually dimorphic chronic autoimmune inflammatory disease affecting multiple organs, characterized by production of autoantibodies against nuclear and cytoplasmic antigens. Like other autoimmune conditions, SLE is more prevalent in females of childbearing age, and very rare in males. Recent evidence implicated the presence of higher genetic risk loads in men. There is strong evidence supporting the contribution of X-linked Toll-like receptor 7 (TLR7) gene polymorphism to the development of SLE with a stronger effect in males than females.
Objective: This study describes the demographic traits, potential risk factors, clinical and laboratory profiles of male lupus patients. The second part is a review of the literature to document the demographic characteristics, possible protective and predisposing
factors, pathophysiology and peculiar characteristics.
Methods: We document findings in the five males who presented with SLE (from a cohort of 108 SLE patients) who presented between May 2015 and June 2017.The second part involved a review of the literature on SLE in males to document the demographic characteristics, possible protective and predisposing factors, pathophysiology and peculiar characteristics. The review involved a literature search using PubMed, Medline, Google Scholar, Africa-wide NiPAD and African Journal online.
Results: Most males with SLE present in the third and fourth decades of life. The most common clinical findings are on the skin, joints, renal and haematology systems. Cutaneous lesions include acute utaneous lupus like malar rash; and chronic cutaneous lupus, ssociated with hair affectation (non-scarring alopecia). Others include serositis (pericardial effusion); renal impairment leading to chronic kidney disease; neuropsychiatric and haematologic (lymphopaenia) features; and positive serology: elevated antinuclear antibody (values from 1/320 to 1/640), raised anti double-stranded DNA, anti SmAb and low complement level.
Conclusions: Males and females both have the classic lupus symptoms, but other clinical characteristics such as a later onset, a more severe form of the disease, and prognosis appear in males.