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Background <p>Although systemic sclerosis (SSc) predominantly affects the female sex, male patients tend to present a more severe visceral profile and worse prognosis. This study aims to analyze the clinical and laboratory characteristics of male patients in a large single SSc cohort.</p> Methods <p>This retrospective study analyzed 700 patients followed regularly at a single tertiary outpatient SSc center. Patients were classified according to the 2013 ACR/EULAR SSc criteria, and all data were retrieved from an electronic database. Statistical analyses included comparing demographic and clinical data, Kaplan-Meier survival curves, and multivariate analyses using SigmaStat 14.5.</p> Results <p>There were 612 women (87.4%) and 88 men (12.6%). Male patients were more frequently African-Brazilians (<i>p</i> = 0.005), and showed a significantly shorter disease duration compared to females (10.1 vs. 13.8 years, <i>p</i> &lt; 0.001), with higher rates of environmental exposures (37.5% vs. 8.2%, <i>p</i> &lt; 0.001), and more severe fibrotic manifestations, including skin thickening score (<i>p</i> = 0.004), diffuse SSc (<i>p</i> = 0.005), and extensive interstitial lung disease (<i>p</i> = 0.013). Men also had higher rates of group 3 pulmonary hypertension (<i>p</i> = 0.018), congestive heart failure (<i>p</i> = 0.001), and required more aggressive treatments such as cyclophosphamide (<i>p</i> &lt; 0.001) and rituximab (<i>p</i> = 0.002). Although there were no significant sex differences in the frequency of vascular manifestations or joint involvement, men had lower rates of positivity for antinuclear antibodies (ANA) (<i>p</i> = 0.047) and anti-centromere antibodies (ACA) (<i>p</i> = 0.001). Male sex was associated with increased mortality (hazard ratio 2.3; 95% CI 1.4 to 3.8; <i>p</i> = 0.002) and survival rates at 1, 3, 5, and 10 years from diagnosis were 99.2%, 96%, 89%, and 75% for men, and 99%, 98%, 97%, and 93% for women (<i>p</i> &lt; 0.001).</p> Conclusion <p>Our study reinforces the association between male sex and more severe SSc, marked by greater skin involvement, worse pulmonary and cardiac outcomes, a higher prevalence of environmental exposures, and lower ACA positivity. These factors contributed to poorer survival outcomes in men compared to women. These findings underscore the need for a more comprehensive evaluation of clinical manifestations to better assess disease progression in male SSc patients.</p>

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Impact of male sex in clinical and laboratory features of systemic sclerosis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月7日

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  • Ana Paula Luppino-Assad,
  • Rodrigo Vidaurre,
  • Osvaldo Camata,
  • Renata Miossi,
  • Adriana Bruscato Bortoluzzo,
  • Eduardo Ferreira Borba,
  • Ana Cristina Medeiros-Ribeiro,
  • Percival D. Sampaio-Barros

摘要

Background

Although systemic sclerosis (SSc) predominantly affects the female sex, male patients tend to present a more severe visceral profile and worse prognosis. This study aims to analyze the clinical and laboratory characteristics of male patients in a large single SSc cohort.

Methods

This retrospective study analyzed 700 patients followed regularly at a single tertiary outpatient SSc center. Patients were classified according to the 2013 ACR/EULAR SSc criteria, and all data were retrieved from an electronic database. Statistical analyses included comparing demographic and clinical data, Kaplan-Meier survival curves, and multivariate analyses using SigmaStat 14.5.

Results

There were 612 women (87.4%) and 88 men (12.6%). Male patients were more frequently African-Brazilians (p = 0.005), and showed a significantly shorter disease duration compared to females (10.1 vs. 13.8 years, p < 0.001), with higher rates of environmental exposures (37.5% vs. 8.2%, p < 0.001), and more severe fibrotic manifestations, including skin thickening score (p = 0.004), diffuse SSc (p = 0.005), and extensive interstitial lung disease (p = 0.013). Men also had higher rates of group 3 pulmonary hypertension (p = 0.018), congestive heart failure (p = 0.001), and required more aggressive treatments such as cyclophosphamide (p < 0.001) and rituximab (p = 0.002). Although there were no significant sex differences in the frequency of vascular manifestations or joint involvement, men had lower rates of positivity for antinuclear antibodies (ANA) (p = 0.047) and anti-centromere antibodies (ACA) (p = 0.001). Male sex was associated with increased mortality (hazard ratio 2.3; 95% CI 1.4 to 3.8; p = 0.002) and survival rates at 1, 3, 5, and 10 years from diagnosis were 99.2%, 96%, 89%, and 75% for men, and 99%, 98%, 97%, and 93% for women (p < 0.001).

Conclusion

Our study reinforces the association between male sex and more severe SSc, marked by greater skin involvement, worse pulmonary and cardiac outcomes, a higher prevalence of environmental exposures, and lower ACA positivity. These factors contributed to poorer survival outcomes in men compared to women. These findings underscore the need for a more comprehensive evaluation of clinical manifestations to better assess disease progression in male SSc patients.