Symptoms of Lupus in Men

posted in Diagnosing Lupus on July 3, 2024 by

Gavin Abson

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While lupus is more common in women, 10% of lupus patients are men. Understanding the symptoms of lupus in men is crucial for early diagnosis and management. This article explores the unique manifestations of lupus in men, how it differs from women, and the importance of recognizing these signs.

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This blog post article was edited and contributed to by Donald Thomas, MD; author of “The Lupus Encyclopedia.” Parts of this blog post come from “The Lupus Encyclopedia: A Comprehensive Guide for Patients and Health Care Providers, edition 2“

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Nick Cannon: An example of overcoming severe lupus

Nick Cannon became very sick while vacationing with his wife, Mariah Carey. He was flown to Cedar-Sinai Hospital and diagnosed with severe lupus nephritis. Nick was so sick that his legs swelled to the size of elephant trunks due to lupus-induced nephrotic syndrome. He is a good example of how men often develop more severe lupus that can come on rapidly. Nick shares his journey and his story, as well as how he lives a wonderful life, though he has such a severe disease, by being adherent to taking his medications, eating healthy, and exercising. Watch all the episodes of his lupus journey on YouTube. If you skip to the 2-minute mark in episode 1, you can see just how sick he got.

Common Symptoms of Lupus in Men

Men with lupus can experience a wide range of symptoms, many of which are similar to those seen in women. However, some differences in the presentation and severity of symptoms exist. The most common symptoms include:

• Fatigue: Fatigue is a prevalent symptom in men with lupus, often severe and debilitating. It can affect daily activities and overall quality of life.
• Joint Pain and Swelling: Joint pain, stiffness, and swelling are common in men with lupus. These symptoms can mimic those of rheumatoid arthritis and typically affect the elbows, hands, wrists, and knees.
• Skin Rashes and Hair Loss: The classic butterfly-shaped rash across the cheeks and nose, known as a malar rash, can occur in men. Other skin manifestations include discoid lupus, photosensitivity, and alopecia (hair loss).
• Fever: Unexplained fevers are a common early sign of lupus in men. These fevers are usually low-grade and can occur intermittently.
• Chest Pain: Men with lupus may experience chest pain, often due to inflammation of the heart (pericarditis) or lungs (pleuritis). Heart attacks are the top killer of men with lupus and occur much earlier than their peers who do not have lupus.

Differences Between Symptoms of Lupus in Men and Women

While men and women share many lupus symptoms, there are notable differences in how the disease manifests and progresses. Research suggests that men with lupus may experience more severe symptoms and a higher risk of certain complications.

Severity and Organ Involvement

Studies have shown that men with lupus tend to have more severe disease activity at diagnosis. They are more likely to develop kidney involvement (lupus nephritis), cardiovascular complications, and neurological symptoms. Men may also experience a higher incidence of blood-related issues, such as hemolytic anemia and thrombocytopenia.

Hormonal Differences

Hormonal differences between men and women may influence the presentation of lupus. Estrogens (female hormones), like estradiol, play a role in the immune response, potentially contributing to the higher prevalence of lupus in women.

Recognizing Early Symptoms of Lupus in Men

Early recognition of lupus symptoms in men is essential for prompt diagnosis and treatment. Men often delay seeking medical attention due to the misconception that lupus primarily affects women. Awareness of the early signs can lead to better outcomes and reduce the risk of severe complications.

Unexplained Fatigue and Fever

Persistent, unexplained fatigue and low-grade fevers should not be ignored. These symptoms can be early indicators of lupus and warrant further investigation, especially if accompanied by other signs like joint pain or skin rashes.

Skin Changes

Men should pay attention to any unusual skin changes, particularly rashes that worsen with sun exposure. The malar (butterfly) rash and discoid lupus are significant indicators of lupus and should prompt a visit to a healthcare provider.

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Diagnosis and Management

Diagnosing lupus in men involves a combination of clinical evaluation, laboratory tests, and imaging studies. Healthcare providers look for a pattern of symptoms and signs, along with specific blood tests to confirm the diagnosis.

Laboratory Tests

Several blood tests help diagnose lupus, including the antinuclear antibody (ANA) test, anti-double-stranded DNA (anti-dsDNA), and anti-Smith (anti-Sm), Coombs antibody, anti-ribosomal-P, EC4d and BC4d. Men with lupus may also have abnormal levels of complement proteins (like EC4d, C3, C4, and CH50) and increased inflammatory markers.

Treatment Options

After getting a lupus diagnosis, there are many things patients can do to help control lupus and get their lives back. The treatment of lupus in men focuses on achieving remission using medications, preventing flares, preventing organ damage, and avoiding steroids as much as possible. Medications commonly used include nonsteroidal antimalarials (like hydroxychloroquine), anifrolumab (Saphnelo), belimumab (Benlysta), voclosporin (Lupkynis), and immunosuppressants (like methotrexate and steroids). The choice of treatment depends on the severity of the disease and the organs involved.

Lifestyle and Self-Care

In addition to medical treatment, lifestyle modifications and self-care are crucial for managing lupus symptoms in men. These strategies can help improve overall health and reduce the impact of the disease.

Regular Exercise

Engaging in regular, low-impact exercise can help manage fatigue, improve joint flexibility, and enhance overall well-being. Activities such as walking, swimming, and yoga are beneficial for men with lupus.

Balanced Diet

A balanced diet rich in fruits, vegetables, lean proteins, and whole grains supports the immune system and overall health. Men with lupus should avoid foods that trigger inflammation and consult a nutritionist for personalized advice.

Stress Management

Stress can exacerbate lupus symptoms, so it is important to adopt stress management techniques. Practices such as meditation, deep breathing exercises, and mindfulness can help reduce stress levels.

Indepth Video about Symptoms of Lupus in Men

See my video about men and lupus, produced by Kaleidoscope Fighting Lupus for more, complete information.

Lupus in Men Section in “The Lupus Encyclopedia”

Below is one section regarding men and lupus from “The Lupus Encyclopedia: A Comphrehensive Guide for Patients and Health Care Providers”:

Although most SLE patients are female, about 10% are male. Sex hormones and lupus-associated genes on the X-chromosome help explain this difference. Men with Klinefelter’s syndrome (with the sex genes XXY) are 14 times more likely to develop lupus than men with the usual XY sex genes.

While women commonly develop SLE during the childbearing years, men are commonly diagnosed with SLE during middle age and older. Both men and women can also develop it in childhood and adolescence.

Men appear to have more lupus nephritis (kidney inflammation), discoid lupus, fevers, weight loss, serositis (such as pleurisy), low blood counts, blood clots, heart attacks, vasculitis (blood vessel inflammation), and seizures than women. Women are more likely to have Raynaud’s phenomenon, arthritis, sun sensitivity, mouth ulcers, and nose ulcers compared to men. Most studies show that men with SLE tend to have more severe disease and more permanent organ damage and are more likely to die prematurely.

Black men tend to be more likely to have a sudden onset of severe SLE than most SLE patients. It is not unusual for a very healthy Black male to become sick with rapid major organ damage and end up in the intensive care unit. On the other end of the spectrum, white women are more likely to gradually add lupus problems over time. Of course, there are always exceptions.

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Understanding the symptoms of lupus in men is vital for early diagnosis and effective management. Men with lupus may experience more severe disease and different patterns of organ involvement compared to women. Recognizing early signs, seeking timely medical attention, and adopting a comprehensive treatment plan can significantly improve outcomes. Lifestyle modifications and self-care play a crucial role in managing lupus symptoms and enhancing the quality of life for men with this chronic condition.

For more in-depth information on Symptoms of Lupus in Men:

Read more in The Lupus Encyclopedia, edition 2

Look up your symptoms, conditions, and medications in the Index of The Lupus Encyclopedia

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