Background/Purpose:
Little is known
about males with systemic lupus erythematosus (SLE), particularly among those
with a recent diagnosis. To better understand the
presentation and outcomes of adult males with SLE we describe the demographic,
clinical and immunological manifestations, and treatment profiles in a small
inception cohort of men with SLE at Santa Clara Valley Medical Center (SCVMC), a
574-bed medical center in Santa Clara County.

Methods: Electronic records
were searched to identify adult males diagnosed with SLE at SCVMC between January
2004 and August 2014 with at least 2 rheumatology clinic visits and documented
SLE diagnosis within one year of their initial visit.   Medical record review
of these incident cases confirmed the diagnosis using ACR classification criteria.
Additional data collected included socio-demographic variables, history of
comorbidities at diagnosis (e.g. myositis, hypertension), clinical and
immunological SLE manifestations, clinical events after diagnosis (e.g.
avascular necrosis, cerebrovascular event, pulmonary embolism) and treatment
profiles. Individuals were followed until either the end of follow-up (August
2014), death, or loss to follow-up.

Results:
Of
the 16 incident male SLE patients identified, the average age at diagnosis was
approximately 32 years and the majority of patients were Hispanic (69%). At
initial presentation the majority of patients had arthritis (81%), history of
hyperlipidemia (69%), and history of hypertension (63%). 44% had a documental serum creatinine >1.5mg/dl with
biopsy-confirmed lupus nephritis (LN) in 6 patients (2 with class 3/4 and 4
with class 5). In the first year 81% were prescribed hydroxychloroquine, 75% corticosteroids,
38% mycophenolate mofetil, and 31% cyclophosphamide. Among the 15 contributing
more at least 2 years of follow-up the use of most of these medications
increased (93% hydroxychloroquine, 80% corticosteroids, 47% mycophenolate
mofetil, and 20% (n=3) started azathioprine) and no patients remained on
cyclophosphamide (the one patient with less than 1yr follow-up was not on this).
Of the 6 men with documented cyclophosphamide treatment during follow-up, all 6
had LN plus 2 had vasculitis and 2 had myositis. Nine of 16 (56%) men had a
notable clinical or catastrophic event during follow-up (Table 1).

Conclusion: In this case series of 16 men with recently onset SLE nearly half of the patients
had elevated serum creatinine documented and 37.5% biopsy confirmed LN. This is
similar to reported LN incidence (44.8%) among a Spanish subset of male SLE
patients (Casas I, et al. ACR Abstract 2014 #2622). More than half experienced at
least one catastrophic event and over 37% of subjects required cyclophosphamide
at one point. This is one of the first studies to look at treatment of male SLE
and more information is needed both with respect to sex differences and male
SLE outcomes.