OBJECTIVE Systemic lupus erythematosus (SLE) predominantly affects women, but previous studies suggest that men with SLE present a more severe disease phenotype. In this study, we investigated a large and well-characterized patient group with the aim of identifying sex differences in disease manifestations, with a special focus on renal involvement. METHODS We studied a Swedish multi-center SLE cohort including 1226 patients (1060 women and 166 men) with a mean follow-up time of 15.8 ± 13.4 years. Demographic data, disease manifestations including ACR criteria, serology and renal histopathology were investigated. Renal outcome and mortality were analyzed in subcohorts. RESULTS Female SLE patients presented more often with malar rash (p < 0.0001), photosensitivity (p < 0.0001), oral ulcers (p = 0.01), and arthritis (p = 0.007). Male patients on the other hand presented more often with serositis (p = 0.0003), renal disorder (p < 0.0001), and immunologic disorder (p = 0.04) by the ACR definitions. With regard to renal involvement, women were diagnosed with nephritis at an earlier age (p = 0.006), while men with SLE had an overall higher risk for progression into end-stage renal disease (ESRD) with a hazard ratio (HR) of 5.1 (95% CI, 2.1-12.5). The mortality rate among men with SLE and nephritis compared with women was HR 1.7 (95% CI, 0.8-3.8). CONCLUSION SLE shows significant sex-specific features, whereby men are affected by a more severe disease with regard to both renal and extra-renal manifestations. Additionally, men are at a higher risk of developing ESRD which may require an increased awareness and monitoring in clinical practice.

中文翻译：

---

系统性红斑狼疮临床表现的性别差异。

目的系统性红斑狼疮（SLE）主要影响女性，但先前的研究表明，患有SLE的男性表现出更严重的疾病表型。在这项研究中，我们调查了一个大型且特征明确的患者组，旨在确定疾病表现中的性别差异，特别关注肾脏受累。方法我们研究了瑞典的多中心SLE队列，包括1226例患者（1060名女性和166名男性），平均随访时间为15.8±13.4年。调查了人口统计学资料，包括ACR标准在内的疾病表现，血清学和肾脏组织病理学。在亚组中分析了肾结局和死亡率。结果女性SLE患者出现黄斑疹（p <0.0001），光敏性（p <0.0001），口腔溃疡（p = 0.01）和关节炎（p = 0.007）的频率更高。另一方面，根据ACR定义，男性患者更常出现浆膜炎（p = 0.0003），肾脏疾病（p <0.0001）和免疫系统疾病（p = 0.04）。关于肾脏受累，女性被诊断为较早年龄的肾炎（p = 0.006），而患有SLE的男性总体上发展为晚期肾病（ESRD）的风险更高，危险比（HR）为5.1 （95％CI，2.1-12.5）。与女性相比，男性SLE和肾炎的死亡率为HR 1.7（95％CI，0.8-3.8）。结论SLE表现出明显的性别特异性，因此男性在肾脏和肾外表现方面都受到更严重疾病的影响。此外，男性罹患ESRD的风险更高，可能需要在临床实践中提高认识和监测。