A man with lupus is something of a rarity – women are nine times more likely to develop the disease but between the ages of 15 and 45, ten percent of lupus cases worldwide are men, and by age fifty, the numbers increase to about 25%. Unfortunately, because women are most often affected, the majority of information available addresses women’s concerns; however, while concerns may differ, the American College of Rheumatology has established a list of eleven symptoms specific to lupus that is still in use today; any four symptoms occurring together indicate a patient has the disease, and it is possible for men or women to display any of the eleven symptoms on this list.
A person’s gender does seem to influence, to some degree, which symptoms develop, and predispose a man or woman to certain types of secondary disease. The familiar butterfly (malar) rash is more likely to appear with women; dry eyes, mouth and sinuses (Sjogren’s syndrome) is also more common, as are hair loss (alopecia,) low levels of platelets (thrombocytopenia) and problems with the central nervous system.
Men are more likely to have kidney (renal) diseases, lung inflammation (pleurisy,) and the reddish, scaly patches and skin lesions characteristic of discoid and subcutaneous lupus. They are also more prone to anemia (low red blood cell count) and abnormal blood clotting.
Lupus in Men Linked To X Chromosome
The chromosome pairs that determine gender are: XX (female) and XY (male.) The Y chromosome is primarily genes that determine whether someone is male or female; the X chromosome, on the other hand, has many additional genes, for traits other than gender. Because there is no equivalent in the Y chromosome, these additional genes are usually expressed (active.) Genes passed from parent to child on the X chromosome are known as “sex-linked,” or “X-linked” genes.
Sex-linked traits aren’t necessarily harmful, but they sometimes cause physical abnormalities or make people more vulnerable to diseases. A man with lupus generally has a slightly irregular form of a particular gene called TLR7 (toll-like receptor 7) on the X half of his chromosomal pair. Toll receptors are responsible for turning the immune response on, directing it and halting it when it is no longer necessary. TLR7 is one of the main triggers for the overactive immune response that leads to lupus.
Because lupus is more common in women, men with lupus often feel as if there are few resources available. Additionally, it is harder for men to talk about the disease and its effects on family, work and relationships. Clear communication is very important, however; people with lupus need a support network of friends and family and should not try to “handle” the disease alone. Communication with a doctor is also vital, as any changes in symptoms could mean a secondary disease has developed. A man with lupus will have unique concerns, but a good relationship with a primary caregiver means those concerns will be addressed with an appropriate treatment plan.
