Geschlechtsspezifi sche Aspekte bei der systemischen Sklerose

Women are 3-4 times more frequently affected by systemic sclerosis than males. Genetic, hormonal and gender-specifi c acquired factors such as environmental conditions or pregnancies may contribute to the dominance of the female population. Despite similar clinical fi ndings 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 genderspecifi c therapy, despite some promising eff ects of hormonal therapies in female SS patients.