P154 Male lupus characteristics from multi-ethnic cohort
Authors: Aldeyarbi Hebatalla , George Susan , Marchan Grifith , Rajakariar Ravindra , Cove-Smith Andrea , Pakozdi Angela , Cunningham Malvina , Lewis Myles , Turner Benjamin , Pyne Debasish 
Published: April 2024

Background/Aims

Systemic lupus erythematous (SLE) is a chronic autoimmune (AI) disease of unknown etiology. It predominantly presents in women and only 1 in 10 of sufferers are men. We sought to examine the clinical pattern in male lupus patients in a tertiary multi-ethnic lupus centre in East London, UK.

Methods

Male lupus patients were identified through review of a pre-existing lupus patients database and clinic lists at Barts Trust. All patients’ electronic notes were reviewed prior to a telephone interview. All the participants fulfilled the ACR 1997 criteria for SLE. Descriptive data analysis was performed for all identified patients.

Results

Fifty-one patients were identified. Sample demographics showed that male lupus was more prevalent among Afro-Caribbeans (37%,n=19), followed by Asians (33%,n=17) and Caucasians (29%,n=15). The median age was 40.5 (IQR:32.5-52.7) years, with median age at SLE diagnosis 28 years (IQR:23-45).Family history of an AI condition was seen in 25%, whilst 14% had a family history specifically of SLE. Possible significant stressor prior to diagnosis reported in 45% (n = 23) patients. Serological evidence of previous infection with EBV, VZV or parvovirus was found in 76%. Although all patients were below the state pension age of 66, more than half were unemployed. The majority of males had multiorgan involvement including renal (67%,n=34), cutaneous (55%,n=28), hematological (45%,n=23), musculoskeletal (31%,n=16), cardiac (27%,n=14), pulmonary (20%,n=10), and neurologic (14%,n=7). Renal biopsy was done in 33/34 renal cases and the showed proliferative class-III/IV in 65%. Hypertension was a significant comorbidity in 39%, 47% had a concomitant AI condition. Juvenile-onset SLE was diagnosed in 6% of the patients with median age at disease onset 10 years (IQR:14-16,100% Caucasians). These males all had kidney nephropathy class-IV/V. Regarding serology, 94% were positive for antinuclear antibody, 40% speckled, 31% homogenous, and 8% for nucleolar and mixed pattern. Two patients ANA test was not recorded but they had confirmed renal/cutaneous biopsy findings.Three-quarters were positive for anti-double stranded DNA. Ro and La antigens were detected in 35% and 8%, while anti-Sm and anti-RNP antibodies were detected in 37% and 43%, respectively. Antiphospholipid antibodies were identified in less than a third, of which 40% presented with thrombotic events. Triple antiphospholipid antibodies was detected in 53%, 20% had LA, 15% had aCL, and 7% had either anti-B2GP1 or aCL/anti-B2GP.

Conclusion

Our dataset demonstrates a higher prevalence in Afro-Caribbean and Asians and a young age of onset (median 28 years) with presentation about 10 years earlier than most other reports. The majority were unemployed and reported significant life-stressors. Over three-quarters of patients had evidence of prior infection.Most of the lupus males had multiorgan involvement and over two-thirds had renal involvement, proliferative class-III/IV. There was a high prevalence of dsDNA, ENA (anti-Ro) and APL.

Disclosure

H. Aldeyarbi: None. S. George: None. G. Marchan: None. R. Rajakariar: None. A. Cove-Smith: None. A. Pakozdi: None. M. Cunningham: None. M. Lewis: None. B. Turner: None. D. Pyne: None.