SEX significantly influences the onset, severity, and progression of systemic lupus erythematosus (SLE), according to a new scoping review that synthesizes data from nearly a decade of clinical research. The findings underscore key biological and clinical disparities that may inform future management strategies for both male and female patients.
The review, based on 81 eligible studies published between 2015 and 2024, focused on adult patients with SLE and evaluated outcomes by sex. The analysis revealed that men tend to develop SLE later in life and experience more severe disease manifestations. These include higher rates of lupus anticoagulant positivity, nephritis, serositis, antiphospholipid syndrome, renal and cardiovascular damage, and serious infections.
In contrast, women with SLE were more likely to present with Ro/SSA autoantibodies, alopecia, photosensitivity, Raynaud’s phenomenon, and osteoporosis. These findings reflect both immunologic and clinical variations, with implications for diagnosis and risk assessment across sexes.
Notably, treatment patterns also differed. Men received cyclophosphamide more frequently and antimalarial therapies less often, while some studies indicated higher rates of non-adherence to azathioprine and mycophenolate among women. However, evidence on treatment adherence remains limited and requires further validation.
Although most studies centered on biological markers and clinical outcomes, only a small subset explored patient-reported outcomes (PROs), highlighting a critical gap in understanding how sex influences lived experiences and quality of life in SLE.
The female-to-male ratio among study participants ranged from 4:1 to 11:1, consistent with known epidemiologic patterns. Nonetheless, the severity of disease in men points to a pressing need for tailored care strategies that consider both sex and gender in SLE management.
This review provides a comprehensive foundation for developing sex-specific diagnostic tools and therapeutic approaches. It also emphasizes the importance of including PROs in future studies to fully capture the patient perspective.
Reference:
Albrecht K et al. Sex- and gender-related differences in systemic lupus erythematosus: a scoping review. Rheumatol Int. 2025;45(7):160.
