Systemic Lupus Erythematosus: Which gender is most affected?

Autoimmune diseases occur when the body produces autoantibodies against its own cells or organs causing damage. About 80% of people diagnosed with an autoimmune disease are women. Systemic Lupus Erythematosus (SLE) is an autoimmune disease that shows a strong sex bias. In fact, women are 9 times more likely to be diagnosed with SLE.

SLE is an autoimmune disease where the immune system attacks its own tissues, leading to further inflammation, organ, and tissue damage. SLE is a relatively uncommon disease with its global incidence being highly variable across the world. In Europe, the incidence of SLE is 6.5–85 patients in every 100,000 people3. African-Caribbean and Hispanic individuals have an increased risk of SLE2.

NHS England released a clinical commissioning policy for rituximab for the treatment of refractory SLE in adults and post-pubescent children.7 The use of rituximab was not licensed prior to the policy update in 2020, with rituximab selectively targeting B cells, hence, reducing the inflammatory response.7 Although this is promising, there is a clear need for greater government support for women with SLE.

SLE is amongst the top 20 leading causes of death in young women8. Despite this, there is currently no cure for SLE. Instead, the aim of treatment is to induce remission, where the disease is under control and the symptoms are minimised or absent9. It is recommended that all patients are treated with the antimalarial drug hydroxychloroquine as this reduces inflammation which drives organ damage. Hydroxychloroquine also helps to control lipid and glucose levels, reducing the risk of cardiovascular disease. During a flare-up, glucocorticoids are administered to help reduce inflammation. If disease activity cannot be controlled with the prior treatments, then immunosuppressants such as methotrexate may be given. If certain autoantibodies are present, the biologic belimumab may be used10.

As mentioned earlier, SLE presents with vague symptoms and is relatively uncommon, leading to misdiagnoses or delays in diagnosis. The earlier treatment begins, the more effective it is likely to be. Awareness of SLE remains low which further hinders diagnosis. The UK annual SLE awareness month in October is helping to raise much-needed awareness and funds for research. General practitioners need additional training to recognise and treat SLE effectively11. GlaxoSmithKline and Exagen are collaborating to create both accurate diagnostic and monitoring tools for SLE to reduce time to diagnosis down from 6 years. Their diagnostic tool will measure cell‑bound complement activation products to hopefully provide a definitive diagnosis of SLE4.

BEAT-Lupus is the UK’s first clinical trial to use a combination of biological treatments. The results from this Phase II clinical trial are promising with treatment with belimumab after rituximab reducing the levels of the autoantibody that drives disease and reduced numbers of severe flare-ups12. Another promising area of research is investigating whether mesenchymal stem cells can be used in the treatment of SLE to dampen the inflammatory response. Early-stage clinical trials suggest that mesenchymal stem cells can be used safely to induce long-term remission and can help to reduce multiorgan injuries in patients with SLE13. Larger scale Phase II clinical studies are underway in the US14.