1. Dr Huberta Quartey , Padiki Narh , Dr Ida Dey.
Clinical Profiles of Males with SLE at their presentation in Korle-Bu Teaching Hospital
Dr Huberta Quartey , Padiki Narh , Dr Ida Dey.

2. Introduction
SLE is a clinically heterogenous autoimmune disease of unknown aetiology
It is characterized serologically by autoantibodies targeting self-proteins, notably ANAs, which are present in virtually all affected individuals.
SLE is said to be rare in Sub-Saharan Africa and even rarer in males.
The incidence of SLE is markedly increased in females of child-bearing age ratio being 8-15:1
Pre-pubertal and post-menopausal ratios are much lower at 2–6:1 and 3–8:1 respectively

3. The pathogenesis of SLE remains incompletely understood but most likely involves the interaction of genetic, hormonal and environmental factors
This striking predominance in females probably relates to the effect of endogenous sex hormones which have complex effects on the immune system
However, a full explanation for why the disease is so uncommon in men remains elusive.
Our study seeks to compare the clinical profiles of the males when the presented in the Korle-Bu teaching Hospital.

4. Method
We retrospectively assessed the medical records of 8 of our male patients diagnosed with Systemic Lupus erythematosus(SLE).
7 were attendant at the rheumatology clinic of Korle-Bu Teaching Hospital which has a patient population of about 200.
One of the patients was on the ward.
The patients history, examination and lab records were obtained
The laboratory tests that were compared were the Hemoglobin, ESR, urine Protein, Creatinine, Complements, C-Reactive protein, Antibody titre levels

5. Results The youngest was 17years The oldest being 38yrs
The mean age being 29.5years
Males have been reported to experience first SLE-related symptoms at a mean age range of 26–38.4 years [9, 16] .which is comparable to our study

6. Results
62.% of the patients were diagnosed in less than a year from onset of symptoms
25% of them diagnosed between 1 to 4years of onset of symptoms
All patients had general complaints on presentation
All patients had their musculoskeletal system affected with half being affected in the large joints and the other half being generalized

7. Results 75% had dermatological complaints 62.5% had CNS complaints
50% has respiratory complaints
37.5% had cardiovascular complaints at presentation

8. Results 75% had an Hemoglobin level of <11g/dl at presentation
25% had an HB between 11-18g/dl
57.1% had an ESR greater than 50
42.9% had an ESR of between 1-20mmfall/hr
66.7% had an elevated CRP
33.3% had a normal CRP

9. Results 50% had ANA antibody titres of 1:320 16.7% : 1:640
33.3% : 1:160
5 patients had a positive ENA
3 had yet done the test
Anti-Ro(SSA)/Anti RNP
Positive in 80%
negative in 20%
Antibody to ENA JO-1
Negative in 4 patients

10. Results Complement C3 57.1% - low 47.9% - normal Complement C4
Creatinine levels
42.9% had normal creatinine levels
42.9 had elevated levels
14.9% had low levels

11. Results Urine RE Urine proteins 2+ -42.9% 1+-28.9% Normal-28.9%
Urine AcR
Normal-33.3%
< %
Urea
57.1%
42.9%- >7.1
One had done renal biopsy which showed a Stage V nephritis

12. Results
Albumin
<35g/dl-57.1%
35-50g/dl-42.9%

13. Discussion
The epidemiology of SLE in people of African origin clearly varies from one geographical setting to another.
It appears to be very rare in West Africa, increasing in frequency in Central and Southern Africa,
and of high frequency in America, the Caribbean and Europe.

14. Discussion From the study the mean age at presentation was 29.5years
Males have been reported to experience first SLE-related symptoms at a mean age range of 26–38.4 years (Murphy et al,2013)
From our study 62% had a less than a year from start of symptoms to diagnosis
The overall trend was to a shorter delay in diagnosis of male patients, with a range of 6–46 months between symptom onset and diagnosis in males (Murphy et al)

15. Discussion
From our study musculoskeletal ,genitourinary and dermatological systems were the most affected at presentation.
According to Font et al(1992) patients of African American extraction frequently exhibit more significant renal disease, hypertension and discoid lupus and less photosensitivity
Discoid lesions and serositis more common compared with arthritis and malar rash less often

16. Discussion
The LUpus in MInorities, NAture versus nurture (LUMINA) cohort is a well-known multiethnic US Cohort consisting of Hispanic, African American, and Caucasian patients
Of the 618 LUMINA patients enrolled at the time of the study, 555 were female, 63 male. Caucasians were overrepresented amongst males.
Musculoskeletal involvement was less frequent in males in this cohort(Schwartzman-Morris et al 2012)

17. There was a lower incidence of musculoskeletal symptoms, alopecia and photosensitivity in men at diagnosis, with the suggestion of more prevalent serositis and discoid lupus. (Murphy et al)
Sthoeger et al observed a higher incidence of neurological disease, nephritis, thrombocytopenia, vasculitis and hepatosplenomegaly in male patients.
Tan et al (2012) found that men were more likely than women to have experienced end organ damage including neuropsychiatric, renal, cardiovascular, peripheral vascular disease, and myocardial infarction.

18. Discussion
Renal disease in SLE is a source of major morbidity and mortality; it develops in approximately 60% of patients with SLE, with a reported 5–22% of these patients progressing to end-stage renal disease requiring dialysis or transplant
Studies have shown that lupus nephritis (LN) is more frequent in men than in women
A recent study by Resende, et al. concluded that lupus nephritis may be more severe in men.In general, men may have more severe disease activity than women

19. Discussion
Multiple factors including male sex, black race, presence of antiphospholipid antibodies, increased creatinine at the time of diagnosis, anemia, frequent nephritic flares, hypertension, and excessive prolonged proteinuria are all considered risk factors for increased progression to end-stage renal disease (ESRD) (Schwartzman Morris et al,2012)
From the study only one of the patients was able to do a renal biopsy which showed a stage V nephritis

20. Conclusion
Overall experience with male patients with SLE is not extensive and the precise frequency of clinical and serological features differs from study to study

21. References
full
Gender Differences in the Pathogenesis and Outcome of Lupus and of Lupus Nephritis
Julie Schwartzman-Morris1,2 and Chaim Putterman2

22. References
Effect of gender on clinical presentation in systemic lupus erythematosus
Grainne Murphy1 and David Isenberg

23. Thank you