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Do children with lupus have fewer male siblings?

Department of Pediatrics, Division of Pediatric Rheumatology, Robert Wood Johnson Medical School-University of Medicine and Dentistry of New Jersey, New Brunswick, NJ, USA, LNMoorthy{at}mac.com, Physician to Ambulatory Care Center, Hospital For Special Surgery, New York, NY, USA

M.G.E. Peterson

Division of Research, Hospital For Special Surgery, New York, NY, USA

K.B. Onel

Department of Pediatrics, Division of Pediatric Rheumatology, La Rabida Children's Hospital, The University of Chicago, Chicago, IL, USA

T.J.A. Lehman

Department of Pediatrics, Weill Medical College of Cornell University, New York, NY, USA, Division of Pediatric Rheumatology, Hospital for Special Surgery, New York, NY, USA

It is widely acknowledged that genetic factors play a significant role in the pathogenesis of systemic lupus erythematosus (SLE). However, the female preponderance remains unexplained. We hypothesized that the female preponderance in childhood SLE results from selection early in the course of conception against male fetuses bearing genetic material predisposing to SLE. If this hypothesis is accurate, there should be a decreased number of male children in families with a child with SLE. Alternatively, children with SLE would have fewer male siblings. Further, this hypothesis may apply to other diseases with a female predominance such as pauciarticular onset juvenile rheumatoid arthritis (PaJRA), and not apply to diseases without female preponderance such as systemic onset juvenile rheumatoid arthritis (SoJRA). Chart review of patients with childhood onset SLE and PaJRA revealed a greater number of female children in these families compared with families of patients with SoJRA. Large-scale epidemiologic studies with precise counting of miscarriages and abortions could help to confirm these findings. Detailed studies of genetic and maternal intrauterine factors are required to conclusively prove this hypothesis. Lupus (2008) 17, 128—131.

Key Words: sex ratio • sibling ratio • SLE

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