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Gender-related differences in systemic sclerosis

Hughes, Michael; Pauling, John D.; Armstrong-James, Laura; Denton, Christopher P.; Galdas, Paul; Flurey, Caroline


Michael Hughes

John D. Pauling

Laura O'Brien
Occasional Associate Lecturer - HAS HSS

Christopher P. Denton

Paul Galdas


Systemic sclerosis (SSc) is a complex autoimmune connective tissue disease which is characterised by autoimmunity, widespread tissue fibrosis of the skin and internal organs, and vasculopathic alterations. SSc is more common in women but has a more severe expression of disease including internal organ-based complications and higher mortality in men. The extant literature shows that although important pathophysiological sex differences are present in SSc, behavioural differences (e.g. higher smoking rates in men) and occupational exposures may contribute to poorer outcomes in men with SSc. The higher death male death rate in the general population and greater prevalence of lung fibrosis are likely the key factors responsible for excess mortality found in men. Other important factors include (but are not limited to) a greater prevalence of the disease subset, delayed time to diagnosis, and higher disease activity in early disease in men. SSc carries a significant burden of disease-related morbidity; however, no qualitative studies to date have focussed on gender differences in SSc. The purpose of this review is to provide a comprehensive overview of gender differences in SSc including (but not limited to) epidemiology, pathophysiology, clinical expression of disease, mortality, SSc in transgender individuals, and psychosocial aspects of disease.


Hughes, M., Pauling, J. D., Armstrong-James, L., Denton, C. P., Galdas, P., & Flurey, C. (2020). Gender-related differences in systemic sclerosis. Autoimmunity Reviews, 19(4),

Journal Article Type Article
Acceptance Date Oct 19, 2019
Online Publication Date Feb 13, 2020
Publication Date Apr 1, 2020
Deposit Date Jul 4, 2020
Journal Autoimmunity Reviews
Print ISSN 1568-9972
Electronic ISSN 1873-0183
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 19
Issue 4
Article Number 102494
Keywords Immunology; Immunology and allergy; Systemic sclerosis; Scleroderma; Gender: men, women; Pathogenesis; Epidemiology; Mortality; Organ-involvement; Treatment
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Additional Information This article is maintained by: Elsevier; Article Title: Gender-related differences in systemic sclerosis; Journal Title: Autoimmunity Reviews; CrossRef DOI link to publisher maintained version:; Content Type: article; Copyright: © 2020 Elsevier B.V. All rights reserved.