Impact of male gender on the clinical phenotype and prognosis in systemic sclerosis

Abstract

Background. Systemic sclerosis (SSc) is a chronic autoimmune disease defined by vascular dysfunction, tissue fibrosis, and autoantibody presence. Prevalence is higher in females, yet males often exhibit more severe forms. Elucidating gender disparities will optimize understanding of disease heterogeneity. Objective(s). To determine the influence of male gender on clinical and paraclinical manifestations, as well as the prognostic evolution of patients diagnosed with Systemic Scleroderma. Materials and methods. A retrospective study was conducted on 20 systemic sclerosis patients (16 females, 4 males) hospitalized in the Rheumatology and Arthrology Department of "Timofei Moșneaga" Republican Clinical Hospital, between 2023–2025. Relevant clinical, paraclinical, and immunological data for staging and prognostic evaluation were analyzed. Results. Of the 20 patients analyzed, 13 (65%) were identified with the diffuse form (dcSSc), with a notably increased frequency in males (75%), while 7 (35%) had the limited form (lcSSc). Raynaud's phenomenon was present in 90% of cases. Pulmonary hypertension was diagnosed in 50% of males, representing a higher prevalence compared to 31.2% in females. Anti-Scl-70 antibodies were positive in 50% of patients, and anti-centromere in 25%, exclusively in lcSSc. Mean time to diagnosis was shorter in males (1.4 years) than females (2.3 years), but onset was more severe. Males showed accelerated progression, therapeutic resistance, and a poor prognosis. Conclusion(s). Male gender was confirmed as a negative prognostic factor in SSc, associated with a severe clinical phenotype, marked by diffuse forms, frequent pulmonary involvement, accelerated progression, and increased mortality, necessitating close monitoring and individualized therapeutic strategies in males.