The impact of gender on clinical manifestations of primary antiphospholipid syndrome

The objective of the study was to determine the clinical differences at diagnosis and during follow- up between male and female patients with primary antiphospholipid syndrome ( PAPS). We analysed 68 patients, 30 males and 38 females diagnosed and followed between 1990 and 2003. Patients with antiphospholipid syndrome associated with systemic lupus erythematosus at onset and during followup were excluded. The mean age at diagnosis was 31.4 +/- 11 years in males and 35.7 +/- 11 years in females ( NS). The follow- up after diagnosis was 8.7 +/- 3.1 years in males and 9.2 +/- 2.9 years in females ( NS). We did not find significant differences between the two groups with respect to venous and arterial thrombosis. However, in female patients, stroke was more prevalent than in male patients ( 12/ 38 versus 3/ 30, P = 0.03). In contrast, we found a significant prevalence of severe gastrointestinal complications in male compared to female patients ( 7/ 30 versus 1/ 38, P = 0.009). One male patient died due to catastrophic antiphospholipid syndrome. This study suggests that clinical course in patients with PAPS may be different with significant prevalence of central nervous system involvement in females and gastrointestinal involvement in males. Factors such as accelerated atherosclerosis, hormones, related to gender could be the explanation of these findings.