Leading the way to a cure

Lupus Research Update: 2012 Volume 2

Volume 2, 2012 - Online Edition | In This Issue

The Science Behind Lupus in Men >
Treating Lupus and Men: From an Expert's Perspective >
Faces of Lupus >

Treating Lupus and Men: From an Expert's Perspective

To grasp a better understanding of the challenges of caring for men with lupus, the ALR looks to Dr. Robert Lahita, world-renowned lupus expert, researcher, physician, and Chairman of Medicine at Newark Beth Israel Medical Center.

In overseeing the hospital's largest department, he has been involved in the treatment of hundreds of men with the disease. Currently, 125 male patients receive their medical care at the facility.

Lupus is a mysterious disease that affects everyone differently — and there are differences and commonalities between men and women who have the disease.

Like most women, men who discover that they have lupus often experience a sense of relief at finally being able to treat symptoms that could have been undiagnosed for years.

Areas of Difference

Although there is no difference in the manifestations of lupus — joint pain, rashes, and general malaise and fatigue — in men and women, many believe that men may have more severe lupus symptoms than women. This point of view has not been substantiated and has not been Dr. Lahita’s experience in treating patients at Newark Beth Israel Medical Center.

Instead, Dr. Lahita has noticed that diagnosis of lupus in men generally comes later in life than in women. For women, symptoms of lupus usually manifest during childbearing years, while symptoms in men generally appear after the age of 50.

Another difference between the sexes is that men with lupus tend to develop more cardio/pulmonary complications and less renal/central nervous system disease than women. Dr. Lahita explained that this occurrence may have more to do with the age of patients at time of diagnosis — because older men are more prone to these ailments, regardless of lupus. However, there are not conclusive studies in this area.

Conversely, women with lupus are much more likely to develop fibromyalgia, an extremely painful condition with a heightened response to pressure. In the general public, fibromyalgia is estimated to affect 2-4% of the population but the shocking female to male ratio is 9-1. "Of all the male patients I see I can only recall two cases of fibromyalgia, but both of these men had unusually high trigger points for it," said Dr. Lahita.

Similarities in Racial Profile

Lupus is two to three times more common among African Americans, Hispanics, Native Americans and Asians — a disparity that remains unexplained.

Dr. Lahita sees a similarity in his patient base: "Many more males of African American, Philippine and Latin American descent have lupus... far more than Caucasians." About 80% of his male lupus patients are non-Caucasian.

Emotional Stresses Unique to Men

Men receiving a diagnosis of lupus may become frustrated and depressed with the thought of having a disease that is known to primarily affect women.

"Some of our male patients at Newark Beth Israel really wonder if something is wrong with their masculinity because of the disease," shared Dr. Lahita. "Others are not particularly fazed."

Still, Dr. Lahita assures all of his male patients that masculinity has nothing to do with the disease — even though they have an unusual metabolism of estrogen. "These men do not have breasts, lack of hair, or anything this is physiologically feminizing. I want to make it absolutely clear, there is nothing feminine about men with lupus," said Dr. Lahita.

He also pointed out that treatments with steroids will gradually lower the level of testosterone, but men with lupus do not have elevated levels of estrogen.

Special Relationship with the ALR

When wearing his researcher hat, Dr. Lahita is a co-investigator on an ALR-funded investigation that looks at interferon 5-receptor expression in patients with active lupus in both men and women at the University of Medicine and Dentistry of New Jersey.

Dr. Lahita is quick to acknowledge the ALR's role in transforming the landscape of lupus research: "The ALR is a tremendous organization. It's approach to novel therapies and novel understanding of the pathogenesis of lupus is second to none."

Robert Lahita, MD, PhD, is Professor of Medicine at the New Jersey Medical School and Chairman of Medicine and Vice President of the Newark Beth Israel Medical Center. He is the editor of Systemic Lupus Erythematosus (in its 5th edition) and Senior Editor of the Textbook of Autoimmunity, Dr. Lahita is the Associate Editor of the Journal Lupus, and the author of Lupus, Q&A: Everything You Need to Know. He is also the author of Women and Autoimmunity: The Mysterious Way Your Body Betrays Itself.

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