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Aktuelle Rheumatologie 2011; 36(06): 366-371
DOI: 10.1055/s-0031-1287801
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© Georg Thieme Verlag KG Stuttgart · New York

Geschlechtsspezifische Aspekte bei der systemischen Sklerose

Gender-Specific Aspects in Systemic Sclerosis
G. Riemekasten
1   Charité, Immunologie/Rheumatologie, Berlin
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Publication History

Publication Date:
09 November 2011 (online)

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Zusammenfassung

Frauen erkranken ca. 3–4 mal häufiger an einer systemischen Sklerose als Männer, wobei neben genetischen und hormonellen Faktoren auch erworbene Faktoren wie die Exposition mit Gefahrstoffen oder möglicherweise auch Schwangerschaften eine Rolle spielen. Die Diagnose wird bei Frauen häufig später gestellt als bei Männern, obgleich dies nicht auf die Symptomatik der Erkrankung zurückgeführt werden kann. Die Klinik zwischen Männern und Frauen mit systemischer Sklerose und der Verlauf der Erkrankung sind nur gering unterschiedlich. Einzig digitale Ulzerationen und eine Verringerung der kardialen Ejektionsfraktion werden bei Männern häufiger nachgewiesen. Funktionelle Beeinträchtigungen sind bei Frauen allerdings größer. Die systemische Sklerose erfasst alle Bereiche des Lebens einschließlich der Sexualität, die sowohl bei Männern als auch bei Frauen beeinträchtigt ist. Die Hospitalisierungsrate ist bei Frauen größer. Während frühere Studien auf eine erhöhte krankheitsbezogene Mortalität bei Männern wiesen, konnte dies in größeren Studien nicht mehr nachgewiesen werden. Die Mortalität bei Frauen ist sowohl in einer Europäischen als auch in einer US-amerikanischen Kohorte in den letzten Jahren gestiegen. In der Schwangerschaft ist das Risiko für das Auftreten von Komplikationen höher, Frühgeburten und eine intrauterine Wachstumsretardierung kommen häufiger vor. Ob geschlechtsspezifische Aspekte auch bei der Therapie der systemische Sklerose eine Rolle spielen könnten, müssen erst weitere Studien zeigen.

Abstract

Women are 3–4 times more frequently affected by systemic sclerosis than males. Genetic, hormonal and gender-specific acquired factors such as environmental conditions or pregnancies may contribute to the dominance of the female population. Despite similar clinical findings in both patient groups, the diagnosis in female patients is often made at a later time point compared to male patients. The clinical course of the disease is not different, digital ulcers and left ventricular dysfunctions are the only manifestations more frequent in male patients. However, the quality of life is more severely affected in female patients and the hospitalisation rate is higher. Both male and female patients suffer from an impairment of their sexuality as a result of the disease. In pregnant SSc patients, the risk of foetal growth retardation and preeclampsia is higher. The slightly higher disease-related mortality of males suggested by some studies is not supported by recent studies showing an increasing mortality in female SSc patients in the last decades in both US-American and European cohorts. As oestrogens directly affect endothelial function, it remains open whether this could lead to a gender-specific therapy, despite some promising effects of hormonal therapies in female SS patients.

Schlüsselwörter

Sklerodermie - systemische Sklerose - Gender - Sex - Hormons

Key words

sclerodemia - systemic sclerosis - gender - sex - hormones
 

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