Background/Purpose: The clinical manifestations and outcomes of systemic lupus erythematosus (SLE) reveal notable gender differences, which may impact treatment strategies and patient outcomes. This meta-analysis aims to evaluate gender disparities in major organ involvement, clinical manifestations, mortality, and prognosis in SLE patients.

Methods: A systematic review was conducted using PRISMA guidelines. Literature searches were performed using PubMed, Embase, and Cochrane Library to identify relevant studies published from inception to April 2024. Data on demographics, clinical manifestations, major organ involvement, mortality rates, and prognosis indicators were extracted. Studies that did not include comparisons between males and females were excluded. Random and fixed effect models were used to assess gender differences, with heterogeneity evaluated using the I² statistic.

Results: Twenty-seven studies involving 29,694 SLE patients, including 2,928 males (11.84%), were analyzed (Figure 1). Major organ involvement was less frequent in females, including higher rates of renal (OR 0.5955; 95% CI: 0.5077-0.6986), neurological (OR 0.7823; 95% CI: 0.6094-1.0044), thrombocytopenia (OR 0.8052; 95% CI: 0.7117-0.9110). and serositis such as pleuritic (OR 0.7655; 95% CI: 0.6378-0.9188) and pericarditis (OR 0.7597; 95% CI: 0.6311-0.9143). Females were more likely to experience malar rash (OR 1.4266; 95% CI: 1.1991-1.6974), oral ulcers (OR 1.2805; 95% CI: 1.0531-1.5570), arthritis (OR 1.4313; 95% CI: 1.3081-1.5661), and leukopenia (OR 1.2652; 95% CI: 1.0483-1.5271). Additionally, females had higher frequencies of anti-SSA (OR 1.4290; 95% CI: 1.0380-1.9671) and anti-SSB antibodies (OR 1.2652; 95% CI: 1.0146-1.5777), while anti-Sm antibodies were less common in females (OR 0.7262; 95% CI: 0.5556-0.9493).

Conclusion: This meta-analysis underscores significant gender disparities in SLE, with major organ involvement, particularly renal, neurological, and cardiovascular manifestations, being more frequent in males. Recognizing these disparities is essential for developing tailored treatment approaches and improving prognostic strategies for SLE patients. Further research is warranted to explore the underlying mechanisms and develop gender-specific interventions.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/gender-disparities-in-clinical-manifestations-and-outcomes-of-systemic-lupus-erythematosus-a-systematic-review-and-meta-analysis/