Differences in disease severity and prognosis between male and female patients with systemic lupus erythematosus

Background. Systemic lupus erythematosus is a multisystemic disorder that affects a variety of internal organs, with the musculoskeletal and skin systems being the most commonly involved. The morbidity and mortality associated with SLE arise from its potential involvement of life-threatening organs. Objectives. To understand the variability in the mode of disease presentation and outcomes among men and women with systemic lupus erythematosus. Materials and methods. This multicenter prospective study included 114 patients with systemic lupus erythematosus receiving ongoing care at three Iraqi medical centers: Al-Yarmouk Teaching Hospital, Baghdad Hospital/Medical City Complex, and Al-Kadhimiya Medical City. The study spanned five consecutive years. Informed written consent was obtained from all participants. Detailed information regarding socio-demographic characteristics, presenting clinical manifestations at diagnosis, and subsequent complications were recorded. Results. Most of the study population were female (80.7%). The mean age was 38.9 ± 14.6 (18–67 years). Almost half of the male group had four systems involved at presentation, while 40% of the female group presented with two systems involved. Complications were higher in the male group, with central nervous system involvement and lupus nephritis being the most significantly associated (40.9% and 27.3%, respectively). Pulmonary complications were higher in the female group. Death and disability were more prevalent in males (13.6%) compared to females (3.3%). Conclusion. The study’s findings demonstrated a substantial association between sex and disease severity, with men exhibiting more pronounced disease progression and poorer clinical outcomes driven by renal and neuropsychiatric involvement compared to women. Early aggressive therapy and smoking cessation programs may mitigate this disparity.