Skip to main content

Main menu

  • Home
  • Content
    • First Release
    • Current
    • Archives
    • Collections
    • Audiovisual Rheum
    • COVID-19 and Rheumatology
  • Resources
    • Guide for Authors
    • Submit Manuscript
    • Payment
    • Reviewers
    • Advertisers
    • Classified Ads
    • Reprints and Translations
    • Permissions
    • Meetings
    • FAQ
    • Policies
  • Subscribers
    • Subscription Information
    • Purchase Subscription
    • Your Account
    • Terms and Conditions
  • About Us
    • About Us
    • Editorial Board
    • Letter from the Editor
    • Duncan A. Gordon Award
    • Privacy/GDPR Policy
    • Accessibility
  • Contact Us
  • JRheum Supplements
  • Services

User menu

  • My Cart
  • Log In

Search

  • Advanced search
The Journal of Rheumatology
  • JRheum Supplements
  • Services
  • My Cart
  • Log In
The Journal of Rheumatology

Advanced Search

  • Home
  • Content
    • First Release
    • Current
    • Archives
    • Collections
    • Audiovisual Rheum
    • COVID-19 and Rheumatology
  • Resources
    • Guide for Authors
    • Submit Manuscript
    • Payment
    • Reviewers
    • Advertisers
    • Classified Ads
    • Reprints and Translations
    • Permissions
    • Meetings
    • FAQ
    • Policies
  • Subscribers
    • Subscription Information
    • Purchase Subscription
    • Your Account
    • Terms and Conditions
  • About Us
    • About Us
    • Editorial Board
    • Letter from the Editor
    • Duncan A. Gordon Award
    • Privacy/GDPR Policy
    • Accessibility
  • Contact Us
  • Follow jrheum on Twitter
  • Visit jrheum on Facebook
  • Follow jrheum on LinkedIn
  • Follow jrheum on YouTube
  • Follow jrheum on Instagram
  • Follow jrheum on RSS
Research ArticleArticle

Differences between Male and Female Systemic Lupus Erythematosus in a Multiethnic Population

TZE CHIN TAN, HONG FANG, LAURENCE S. MAGDER and MICHELLE A. PETRI
The Journal of Rheumatology April 2012, 39 (4) 759-769; DOI: https://doi.org/10.3899/jrheum.111061
TZE CHIN TAN
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
HONG FANG
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
LAURENCE S. MAGDER
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
MICHELLE A. PETRI
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: mpetri@jhmi.edu
  • Article
  • Figures & Data
  • Info & Metrics
  • References
  • PDF
  • eLetters
PreviousNext
Loading

Abstract

Objective. Male patients with systemic lupus erythematosus (SLE) are thought to be similar to female patients with SLE, but key clinical characteristics may differ. Comparisons were made between male and female patients with SLE in the Hopkins Lupus Cohort.

Methods. A total of 1979 patients in the Hopkins Lupus Cohort were included in the analysis.

Results. The cohort consisted of 157 men (66.2% white, 33.8% African American) and 1822 women (59.8% white, 40.2% African American). The mean followup was 6.02 years (range 0–23.73). Men were more likely than women to have disability, hypertension, thrombosis, and renal, hematological, and serological manifestations. Men were more likely to be diagnosed at an older age and to have a lower education level. Women were more likely to have malar rash, photosensitivity, oral ulcers, alopecia, Raynaud’s phenomenon, or arthralgia. Men were more likely than women to have experienced end organ damage including neuropsychiatric, renal, cardiovascular, peripheral vascular disease, and myocardial infarction, and to have died. In general, differences between males and females were more numerous and striking in whites, especially with respect to lupus nephritis, abnormal serologies, and thrombosis.

Conclusion. Our study suggests that there are major clinical differences between male and female patients with SLE. Differences between male and female patients also depend on ethnicity. Future SLE studies will need to consider both ethnicity and gender to understand these differences.

Key Indexing Terms:
  • SYSTEMIC LUPUS ERYTHEMATOSUS
  • GENDER
  • MALE LUPUS

Male lupus is rare, comprising 4%–22% of patients with systemic lupus erythematosus (SLE)1,2,3,4,5,6,7,8 in different series. Despite numerous studies comparing male and female patients, no consistent differences or characteristics have emerged9,10. Male patients had more renal involvement in some, but not all, series7,11,12,13,14,15,16. An increased risk of renal failure in males was seen in 2 studies7,14. Male patients had more neurological involvement3,7,9,17, thrombotic events9,14,15,17, cardiovascular damage14,16,17, serositis6,8,11,18, arthritis19, hepatomegaly19, low C312, thrombocytopenia13, later disease onset3,20, fever12, infection17,21, weight loss12, and hypertension12 in some, but not all, series. In terms of serology, anticardiolipin antibodies9,12,14, anti-dsDNA15, and lupus anticoagulant (LAC)10 were more prevalent in men in a few studies (summarized in Table 1).

View this table:
  • View inline
  • View popup
Table 1.

Studies of male versus female SLE.

There have also been reports of manifestations that occur less often in men, such as skin involvement6,17,19, hematological involvement1,11,21,22, serological involvement11,16,21, Raynaud’s phenomenon (RP)13,15,16,17,19, and arthritis6,10,18,21 in some, but not all, series.

The Hopkins Lupus Cohort offered a unique opportunity to compare male versus female SLE, in the largest cohort with systematic followup every 3 months to ensure complete identification of clinical and serologic manifestations. This cohort also offers an opportunity to compare male versus female SLE separately in white and African American patients.

MATERIALS AND METHODS

Study population

The Hopkins Lupus Cohort, established in 1987, comprises patients with SLE receiving ongoing care at the Hopkins Lupus Center. This study has been approved on an annual basis by the Johns Hopkins Hospital Institutional Review Board. Informed written consent is obtained from all subjects. Subjects enrolled in the cohort have clinic visits at 3-month intervals, or more frequently if medically necessary. Ninety-five percent of the patients met the revised American College of Rheumatology (ACR) classification criteria for SLE23. The proportions of males to females in the 5% who did not fulfill these criteria were slightly higher than those who did (0.15 vs 0.08). Information recorded at cohort entry (and updated at each visit) consists of basic demographic characteristics (date of birth, age at SLE onset, ethnicity, sex, socioeconomic status, years of education, combined annual household income) and presenting and cumulative clinical manifestations. At each patient visit, disease activity was assessed by the physician’s global assessment (0 to 3 on visual analog scale) and the Safety of Estrogens in Lupus Erythematosus National Assessment – Systemic Lupus Erythematosus Disease Activity Index24. Laboratory tests included the complete blood cell count, erythrocyte sedimentation rate, serum creatinine, cholesterol, urinalysis, urine protein to creatinine ratio, C3, C4, and anti-dsDNA. The Systemic Lupus International Collaborating Clinics/ACR Damage Index25 was performed at cohort entry and updated at each visit.

Patients

There were 2121 patients in the entire Hopkins Lupus Cohort. We excluded 142 patients who were not white or African American for simplicity. A total of 1979 patients with SLE in the Hopkins Lupus Cohort were included in our analysis. There were 157 men (66.2% whites, 33.8% African Americans, mean age 49.8 ± 13.8 yrs) and 1822 women (59.8% whites, 40.2% African Americans, mean age at entry 37.6 ± 12.9 yrs). Cumulative ACR criteria included 51.4% malar rash, 20.2% discoid rash, 54.3% photosensitivity, 51.4% oral ulcers, 74.1% arthritis, 44.4% pleuritis, 22.5% pericarditis, 41.2% proteinuria, 9.9% seizures, 3.8% psychosis, 10.3% hemolytic anemia, 43.6% leukopenia, 39.6% lymphopenia, 20.2% thrombocytopenia, 62.2% anti-dsDNA, 18.0% anti-Sm, 26.6% LAC, 48.5% anticardiolipin, and 96.5% positive antinuclear antibody. The mean duration of followup in the cohort was 6.02 years (range 0–23.73 yrs). The mean age at last assessment for men was 47.3 ± 13.7 years and for women 43.7 ± 13.5 years. The mean duration of SLE at last assessment for men was 10.2 ± 7.6 years and for women 11.1 ± 8.5 years.

Statistical analysis

Male and female patients with SLE were compared with respect to demographic characteristics, clinical manifestations, serologic results, and therapy, using chi-square tests (SAS Institute, Cary, NC, USA). P values were then adjusted for ethnicity, history of smoking, age at last assessment, and duration of SLE at last assessment unless specified. Subsequent analyses focused on African Americans or whites separately and the comparison between African American and white males. A p value ≤ 0.05 was considered statistically significant, but OR are presented to allow the reader to assess clinical importance.

RESULTS

Clinical and laboratory manifestations in male and female patients

Demographic, clinical, and laboratory variables are summarized in Table 2. Men were more likely than women to have disability, lymphopenia, thrombocytopenia, positive anti-Sm, direct Coombs test, LAC, low C3, and anti-dsDNA. Men were also more likely to have had renal involvement, thrombotic events, and hypertension, compared to women. Men were more likely to be diagnosed at an older age and to have a lower education level than women. Men were less likely to have had malar rash, photosensitivity, oral ulcer, alopecia, RP, and arthralgias than women.

View this table:
  • View inline
  • View popup
Table 2.

Comparison of cumulative clinical and laboratory features between male and female SLE (n = 1979).

Damage in male and female patients

Organ damage is summarized in Table 3 using the variables of the SLICC/ACR Damage Index. Men were more likely than women to have had neuropsychiatric, renal or cardiovascular manifestations, peripheral vascular disease, and myocardial infarction (MI), and to have died.

View this table:
  • View inline
  • View popup
Table 3.

SLICC/ACR Damage Index comparison between male and female SLE (n = 1979).

Gender differences by ethnicity

Table 4 summarizes comparisons in the African American subset (n = 785). African American men were more likely to have had disability, history of smoking, proteinuria, and renal insufficiency than African American women. African American men were more likely to be diagnosed at an older age. They were also more likely than African American women to have neuropsychiatric, renal, and cardiovascular damage or to have died. However, they were less likely to have had alopecia.

View this table:
  • View inline
  • View popup
Table 4.

Comparison of male and female African American SLE (n = 785).

Comparisons of white patients are shown in Table 5. White males were more likely than white women to have had obesity, disability, thrombocytopenia, a positive Coombs test, LAC, anti-Sm, anti-dsDNA, low C3, hypertension, and deep vein thrombosis. White men were also more likely to be diagnosed at an older age. In addition, they also had more renal manifestations such as proteinuria, nephrotic syndrome, hematuria, renal insufficiency, renal failure, and abnormal renal biopsy. They were more likely to experience neuropsychiatric, renal, cardiovascular, and musculoskeletal damage than white women. Endstage renal disease occurred in 6.7% of white men compared to 2.6% of white women (adjusted p value = 0.0141). White men were less likely than white women to have had malar rash, photosensitivity, oral ulcers, alopecia, or RP.

View this table:
  • View inline
  • View popup
Table 5.

Comparison of male and female white SLE (n = 1194).

To further investigate the differences related to ethnicity, a comparison between white and African American males was performed (Table 6). African American men were more likely to have had discoid rash, alopecia, renal involvement such as proteinuria and renal insufficiency, and anti-Sm than white men. They were more likely to have later onset of lupus and to have a lower education level. However, they were less likely to have LAC. In addition, African American men were more likely than white men to have renal, pulmonary, and cardiovascular damage, and to have died.

View this table:
  • View inline
  • View popup
Table 6.

Comparison of African American (AA) and white male SLE (n =157).

DISCUSSION

Male lupus has been thought to be clinically similar to female lupus7. Studies have reached conflicting results (Table 1), although several found arthritis to be less common in men with SLE. Several studies have found more organ damage in men, in particular renal insufficiency/failure. Our study has the largest number of men (except for the Veterans Administration study20, which did not systematically examine disease manifestations) and the largest prospective followup. In addition, the ethnic makeup of the Hopkins Lupus Cohort allowed us to look separately at white and African American male SLE.

We observed differences between men and women with respect to a large number of disease manifestations and outcomes. Among the differences found in our study, some dermatologic features such as oral ulcer and alopecia, some serologic tests such as LAC, and the renal manifestations such as renal insufficiency and renal failure, had OR > 2.0 or < 0.5, suggesting differences of substantial clinical importance.

In the all-patient analyses (Table 2), men were more likely than women to have had lymphopenia, thrombocytopenia, direct Coombs, LAC, anti-Sm, low C3, and anti-dsDNA. The striking increase in manifestations of hematologic and serologic lupus was suggested in one previous study that found an increase in thrombocytopenia13, one that found an increase in hemolytic anemia and low C312, and one that found an increase in anti-dsDNA15. The increase in LAC was reported in only one previous study10, but 3 studies found an increase in anticardiolipin9,12,14.

Men were more likely to have had an MI. This may be partially explained by the increase in several risk factors, including hypertension and LAC. In contrast, men were less likely to have dermatologic manifestations, including malar rash, photosensitive rash, oral ulcers, alopecia, and RP. A decreased frequency of RP has been found in 3 previous studies13,16,17. A decrease in alopecia was reported in 3 previous studies13,16,17. Our study differs strikingly from several others10,18,21 that found less arthritis in male SLE: there was no difference at all in our analysis. But our results agreed with 2 recent studies13,17 that found less arthralgia in male SLE.

We next analyzed white and African American lupus separately and did a direct comparison between African American and white men. African American men (compared to African American women) were more likely to have a history of smoking and less likely to have alopecia. African American men had a major increase in renal impairment and in death, compared to African American women. White men had less malar rash, photosensitivity, oral ulcers, alopecia, and RP than white women. They had more direct Coombs, thrombocytopenia, and LAC, and more obesity and hypertension than white women. African American men had more dermatologic lupus and more organ damage, including renal, pulmonary, and cardiovascular damage, than white men.

Strikingly, all damage differences except hypertension between male and female patients, and proteinuria between African American male and female patients, achieved an OR > 2.0, which strongly indicated that male patients with SLE had much more severe organ damage than female patients with SLE.

The substantial gender difference in disease manifestations is likely not just due to differences in estrogen or testosterone levels. Lu, et al26 reviewed a number of hypotheses to explain the underlying mechanism of gender differences, including the sex hormone hypothesis, the sex chromosome hypothesis, and the intrauterine selection hypothesis. In mice, Y chromosome polymorphism, X chromosome inactivation, X chromosome gene dosage and parental imprint can all affect autoimmunity27,28,29,30,31,32. Although SLE was found to be of greater severity in female than in male mice33, many studies, including our own, suggest the opposite is true for many organ manifestations in humans. Another possible explanation for some gender differences is that male patients are less likely to seek medical assistance, which might lead to later presentation, with more clinical manifestations, and lead to more organ damage and mortality. This might be part of the reason why, in our study, men tended to have later onset of SLE and diagnosis. Nevertheless, it remains unknown why male SLE differs substantially from female SLE and has a more severe expression in some organs.

There are major clinical differences between male and female lupus: more renal and hematologic lupus in males and less dermatologic lupus in males. Some of these differences, such as more proteinuria and hematuria, are found only in white patients. Men, regardless of ethnicity, had more renal insufficiency. Ethnicity greatly affected the results. White men had more MI than white women, but African American men did not have more MI than African American women. Studies of SLE are needed to analyze not just ethnicity but also gender, to further understand these differences and their underlying mechanisms.

Footnotes

  • The Hopkins Lupus Cohort is supported by NIH R01AR043727.

  • Accepted for publication November 29, 2011.

REFERENCES

  1. 1.↵
    1. Miller MH,
    2. Urowitz MB,
    3. Gladman DD,
    4. Killinger DW
    . Systemic lupus erythematosus in males. Medicine 1983;62:327–34.
    OpenUrlPubMed
  2. 2.↵
    1. Lahita RG,
    2. Chiorazzi N,
    3. Gibofsky A,
    4. Winchester RJ,
    5. Kunkel HG
    . Familial systemic lupus erythematosus in males. Arthritis Rheum 1983;26:39–44.
    OpenUrlPubMed
  3. 3.↵
    1. Hochberg MC,
    2. Boyd RE,
    3. Ahearn JM,
    4. Arnett FC,
    5. Bias WB,
    6. Provost TT,
    7. et al.
    Systemic lupus erythematosus: A review of clinico-laboratory features and immunogenetic markers in 150 patients with emphasis on demographic subsets. Medicine 1985;64:285–95.
    OpenUrlPubMed
  4. 4.↵
    1. Sthoeger ZM,
    2. Geltner D,
    3. Rider A,
    4. Bentwich Z
    . Systemic lupus erythematosus in 49 Israeli males: A retrospective study. Clin Exp Rheumatol 1987;5:233–40.
    OpenUrlPubMed
  5. 5.↵
    1. Kaufman LD,
    2. Gomez-Reino JJ,
    3. Heinicke MH,
    4. Gorevic PD
    . Male lupus: retrospective analysis of the clinical and laboratory features of 52 patients, with a review of the literature. Semin Arthritis Rheum 1989;18:189–97.
    OpenUrlCrossRefPubMed
  6. 6.↵
    1. Font J,
    2. Cervera R,
    3. Navarro M,
    4. Pallarés L,
    5. López-Soto A,
    6. Vivancos J,
    7. et al.
    Systemic lupus erythematosus in men: Clinical and immunological characteristics. Ann Rheum Dis 1992;51:1050–2.
    OpenUrlAbstract/FREE Full Text
  7. 7.↵
    1. Ward MM,
    2. Studenski S
    . Systemic lupus erythematosus in men: A multivariate analysis of gender differences in clinical manifestations. J Rheumatol 1990;17:220–4.
    OpenUrlPubMed
  8. 8.↵
    1. Aydintug AO,
    2. Domenech I,
    3. Cervera R,
    4. Khamashta MA,
    5. Jedryka-Goral A,
    6. Vianna JL,
    7. et al.
    Systemic lupus erythematosus in males: Analysis of clinical and laboratory features. Lupus 1992;1:295–8.
    OpenUrlPubMed
  9. 9.↵
    1. Aranow C,
    2. Guidice JD,
    3. Barland P,
    4. Weinstein A
    . Systemic lupus erythematosus disease severity in men and women: A case-control study. J Rheumatol 2002;29:1674–7.
    OpenUrlAbstract/FREE Full Text
  10. 10.↵
    1. Andrade RM,
    2. Alarcon GS,
    3. Fernandez M,
    4. Apte M,
    5. Vila LM,
    6. Reveille JD
    . Accelerated damage accrual among men with systemic lupus erythematosus. Arthritis Rheum 2007;56:622–30.
    OpenUrlCrossRefPubMed
  11. 11.↵
    1. Voulgari PV,
    2. Katsimbri P,
    3. Alamanos Y,
    4. Drosos AA
    . Gender and age differences in systemic lupus erythematosus. A study of 489 Greek patients with a review of the literature. Lupus 2002;11:722–9.
    OpenUrlAbstract/FREE Full Text
  12. 12.↵
    1. Garcia MA,
    2. Marcos JC,
    3. Marcos AI,
    4. Pons-Estel BA,
    5. Wojdyla D,
    6. Arturi A,
    7. et al.
    Male systemic lupus erythematosus in a Latin-American inception cohort of 1214 patients. Lupus 2005;14:938–46.
    OpenUrlAbstract/FREE Full Text
  13. 13.↵
    1. Mongkoltanatus J,
    2. Wangkaew S,
    3. Kasitanon N,
    4. Louthrenoo W
    . Clinical features of Thai male lupus: an age-matched controlled study. Rheumatol Int 2008;28:339–44.
    OpenUrlCrossRefPubMed
  14. 14.↵
    1. Specker C,
    2. Becker A,
    3. Lakomek HJ,
    4. Bach D,
    5. Grabensee B
    . Systemic lupus erythematosus in men — A different prognosis? Z Rheumatol 1994;53:339–45.
    OpenUrlPubMed
  15. 15.↵
    1. Molina JF,
    2. Drenkard C,
    3. Molina J,
    4. Cardiel MH,
    5. Uribe O,
    6. Anaya JM,
    7. et al.
    Systemic lupus erythematosus in males. A study of 107 Latin American patients. Medicine 1996;75:124–30.
    OpenUrlPubMed
  16. 16.↵
    1. Mok CC,
    2. Lau CS,
    3. Chan TM,
    4. Wong RW
    . Clinical characteristics and outcome of southern Chinese males with systemic lupus erythematosus. Lupus 1999;8:188–96.
    OpenUrlAbstract/FREE Full Text
  17. 17.↵
    1. Stefanidou S,
    2. Benos A,
    3. Galanopoulou V,
    4. Chatziyannis I,
    5. Kanakoudi F,
    6. Aslanidis S,
    7. et al.
    Clinical expression and morbidity of systemic lupus erythematosus during a post-diagnostic 5-year follow-up: A male:female comparison. Lupus 2011;20:1090–4.
    OpenUrlAbstract/FREE Full Text
  18. 18.↵
    1. Cervera R,
    2. Khamashta MA,
    3. Font J,
    4. Sebastiani GD,
    5. Gil A,
    6. Lavilla P,
    7. et al.
    Systemic lupus erythematosus: Clinical and immunologic patterns of disease expression in a cohort of 1,000 patients. The European Working Party on Systemic Lupus Erythematosus. Medicine 1993;72:113–24.
    OpenUrlPubMed
  19. 19.↵
    1. Keskin G,
    2. Tokgoz G,
    3. Duzgun N,
    4. Duman M,
    5. Kinikli G,
    6. Olmez U,
    7. et al.
    Systemic lupus erythematosus in Turkish men. Clin Exp Rheumatol 2000;18:114–5.
    OpenUrlPubMed
  20. 20.↵
    1. Prete PE,
    2. Majlessi A,
    3. Gilman S,
    4. Hamideh F
    . Systemic lupus erythematosus in men: A retrospective analysis in a Veterans Administration healthcare system population. J Clin Rheumatol 2001;7:142–50.
    OpenUrlCrossRefPubMed
  21. 21.↵
    1. Koh WH,
    2. Fong KY,
    3. Boey ML,
    4. Feng PH
    . Systemic lupus erythematosus in 61 Oriental males. A study of clinical and laboratory manifestations. Br J Rheumatol 1994;33:339–42.
    OpenUrlAbstract/FREE Full Text
  22. 22.↵
    1. Pande I,
    2. Malaviya AN,
    3. Sekharan SG,
    4. Kailash S,
    5. Uppal SS,
    6. Kumar A
    . SLE in Indian men: Analysis of the clinical and laboratory features with a review of the literature. Lupus 1994;3:181–6.
    OpenUrlAbstract/FREE Full Text
  23. 23.↵
    1. Hochberg MC
    . Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus [letter]. Arthritis Rheum 1997;40:1725.
    OpenUrlCrossRefPubMed
  24. 24.↵
    1. Petri M,
    2. Kim MY,
    3. Kalunian KC,
    4. Grossman J,
    5. Hanh BH,
    6. Sammaritano LR,
    7. et al.
    Combined oral contraceptives in women with systemic lupus erythematosus. N Engl J Med 2005;353:2550–8.
    OpenUrlCrossRefPubMed
  25. 25.↵
    1. Gladman D,
    2. Ginzler E,
    3. Goldsmith C,
    4. Fortin P,
    5. Liang M,
    6. Urowitz M,
    7. et al.
    The development and initial validation of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index for systemic lupus erythematosus. Arthritis Rheum 1996;39:363–9.
    OpenUrlCrossRefPubMed
  26. 26.↵
    1. Lu L-J,
    2. Wallace DJ,
    3. Ishimori ML,
    4. Scofield RH,
    5. Weisman MH
    . Male systemic lupus erthematosus: A review of sex disparities in this disease. Lupus 2010;19:119–29.
    OpenUrlAbstract/FREE Full Text
  27. 27.↵
    1. Teuscher C,
    2. Noubade R,
    3. Spach K,
    4. McElvany B,
    5. Bunn JY,
    6. Fillmore PD,
    7. et al.
    Evidence that the Y chromosome influences autoimmune disease in male and female mice. Proc Nat Acad Sci USA 2006;103:8024–9.
    OpenUrlAbstract/FREE Full Text
  28. 28.↵
    1. Ozcelik T
    . X chromosome inactivation and female predisposition to autoimmunity. Clinic Rev Allerg Immunol 2008;34:348–51.
    OpenUrlCrossRef
  29. 29.↵
    1. Selmi C
    . The X in sex: How autoimmune diseases revolve around sex chromosomes. Best Pract Res Clin Rheumatol 2008;22:913–22.
    OpenUrlCrossRefPubMed
  30. 30.↵
    1. Smith-Bouvier DL,
    2. Divekar AA,
    3. Sasidhar M,
    4. Du S,
    5. Tiwari-Woodruff SK,
    6. King JK,
    7. et al.
    A role for sex chromosome complement in the female bias in autoimmune disease. J Exp Med 2008;12:1099–108.
    OpenUrl
  31. 31.↵
    1. Arnold AP,
    2. Chen X
    . What does the “four core genotypes” mouse model tell us about sex differences in the brain and other tissues? Front Neuroendocrinol 2009;30:1–9.
    OpenUrlCrossRefPubMed
  32. 32.↵
    1. Lemos B,
    2. Branco AT,
    3. Hartl DL
    . Epigenetic effects of polymorphic Y chromosomes modulate chromatin components, immune response, and sexual conflict. Proc Nat Acad Sci USA 2010;107:15826–31.
    OpenUrlAbstract/FREE Full Text
  33. 33.↵
    1. Zandman-Goddard G,
    2. Peeva E,
    3. Shoenfeld Y
    . Gender and autoimmunity. Autoimmun Rev 2007;6:366–72.
    OpenUrlCrossRefPubMed
View Abstract
PreviousNext
Back to top

In this issue

The Journal of Rheumatology
Vol. 39, Issue 4
1 Apr 2012
  • Table of Contents
  • Table of Contents (PDF)
  • Index by Author
  • Editorial Board (PDF)
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word about The Journal of Rheumatology.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Differences between Male and Female Systemic Lupus Erythematosus in a Multiethnic Population
(Your Name) has forwarded a page to you from The Journal of Rheumatology
(Your Name) thought you would like to see this page from the The Journal of Rheumatology web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Differences between Male and Female Systemic Lupus Erythematosus in a Multiethnic Population
TZE CHIN TAN, HONG FANG, LAURENCE S. MAGDER, MICHELLE A. PETRI
The Journal of Rheumatology Apr 2012, 39 (4) 759-769; DOI: 10.3899/jrheum.111061

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero

 Request Permissions

Share
Differences between Male and Female Systemic Lupus Erythematosus in a Multiethnic Population
TZE CHIN TAN, HONG FANG, LAURENCE S. MAGDER, MICHELLE A. PETRI
The Journal of Rheumatology Apr 2012, 39 (4) 759-769; DOI: 10.3899/jrheum.111061
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One
Bookmark this article

Jump to section

  • Article
    • Abstract
    • MATERIALS AND METHODS
    • RESULTS
    • DISCUSSION
    • Footnotes
    • REFERENCES
  • Figures & Data
  • Info & Metrics
  • References
  • PDF
  • eLetters

Related Articles

Cited By...

More in this TOC Section

  • Clinimetric Validation of the Assessment of Spondyloarthritis International Society Health Index in Patients With Radiographic Axial Spondyloarthritis in Ixekizumab Trials
  • Sex-Specific Differences in Patients With Psoriatic Arthritis: A Systematic Review
  • Clustering Patients With Gout Based on Comorbidities and Biomarkers: A Cross-Sectional Study
Show more Articles

Similar Articles

Content

  • First Release
  • Current
  • Archives
  • Collections
  • Audiovisual Rheum
  • COVID-19 and Rheumatology

Resources

  • Guide for Authors
  • Submit Manuscript
  • Author Payment
  • Reviewers
  • Advertisers
  • Classified Ads
  • Reprints and Translations
  • Permissions
  • Meetings
  • FAQ
  • Policies

Subscribers

  • Subscription Information
  • Purchase Subscription
  • Your Account
  • Terms and Conditions

More

  • About Us
  • Contact Us
  • My Alerts
  • My Folders
  • Privacy/GDPR Policy
  • RSS Feeds
The Journal of Rheumatology
The content of this site is intended for health care professionals.
Copyright © 2022 by The Journal of Rheumatology Publishing Co. Ltd.
Print ISSN: 0315-162X; Online ISSN: 1499-2752
Powered by HighWire