Gender-Based Differences in Clinical, Immunological and Disease Activity Profiles of Systemic Lupus Erythematosus Patients in Bangladesh.

Abstract

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with well-recognized female predominance; however, disease expression and severity may differ by gender. Data on gender-based differences in SLE from Bangladesh remain limited. This study aimed to compare sociodemographic characteristics, clinical manifestations, immunological profiles and disease activity indicators between male and female patients with SLE. This cross-sectional study was conducted at the Lupus Clinic, Department of Rheumatology, Bangladesh Medical University (BMU), Dhaka, Bangladesh, from December 2019 to January 2021. A total of 140 patients who fulfilled the classification criteria for SLE were enrolled, including 130 females and 10 males. Demographic data, clinical features, immunological and serological parameters, Safety of Estrogens in Systemic Lupus Erythematosus National Assessment-Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI) and Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC/ACR DI) were analyzed and compared by gender. The female-to-male ratio was approximately 13:1. Male patients presented at younger ages (p=0.002) and had earlier disease onset than females (p=0.011). Lupus nephritis was significantly more frequent among male patients (p=0.037). Anti-dsDNA levels were higher in male patients, though not statistically significant; complement (C3) levels were significantly lower in male patients (p=0.014). Male patients had significantly higher disease activity (SELENA-SLEDAI) scores than females (p=0.044), whereas cumulative organ damage was comparable. Despite lower prevalence, male SLE patients exhibited more severe disease manifestations and higher activity. These findings underscore the importance of heightened clinical vigilance and gender-sensitive management strategies in SLE.