Rheumatoid arthritis: worse in women?

Tuulikki Sokka from the Jyvaskyla Central Hospital, Finland, along with other members of the Quantitative Standard Monitoring of Patients with RA (QUEST-RA) program, explored possible associations between gender and disease activity measures, treatments, and clinical characteristics in more than 6,000 RA patients from 70 sites in 25 countries.

She said, “The possible influence of gender and gender-related variables on the symptoms, severity, and prognosis of rheumatoid arthritis has been of considerable interest for some time. Generally, women report more severe symptoms, greater disability, and often have higher work disability rates than men.”

The demographic characteristics of the group the authors studied were typical of an RA cohort; 79% were female, more than 90% were Caucasians and the mean age was 57 years. The patients were evaluated by a doctor and completed a self-report about their own condition. Women had higher scores (indicating poorer status) than men in all of the key measures, the gender gap being widest in the self-reported measures.

According to Sokka, “Obvious differences between genders exist in the prevalence, age at onset, and level of production of harmful arthritis autoantibodies. Furthermore, women report more symptoms and poor scores on most questionnaires, including scores for pain, depression, and other health-related items”.

However, the authors do speculate that most of gender differences may originate from the measures of disease activity rather than from the RA disease activity itself. Sokka said, “Women have less strength than men, which has as much of a major effect in the functional status of patients with RA as it does in the healthy population.

In fact, the gender differences in musculoskeletal performance remain even among the fittest individuals – female and male athletes still compete separately. Given that woman is the “weaker vessel” concerning musculoskeletal size and strength and her baseline values are lower than men’s, the same burden of a musculoskeletal disease may appear to be more harmful to a woman than to a man.”