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Sex Differences in Rheumatoid Arthritis: New Insights From Clinical and Patient-Reported Outcome Perspectives.

Gonul Hazal Koc1, Agnes E M Looijen2, Irene E van der Horst-Bruinsma3

  • 1G.H. Koc, MD, Department of Rheumatology, Erasmus MC, Rotterdam, the Netherlands.

The Journal of Rheumatology
|March 5, 2025
PubMed
Summary
This summary is machine-generated.

Female rheumatoid arthritis (RA) patients experience higher disease activity and functional impairment, requiring more biologic disease-modifying antirheumatic drugs (bDMARDs). These findings highlight the need for sex-specific RA management strategies.

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Area of Science:

  • Rheumatology
  • Clinical Immunology
  • Epidemiology

Background:

  • Sex-based differences in rheumatoid arthritis (RA) disease course and burden are poorly understood.
  • Existing data on sex disparities in RA outcomes are limited and often contradictory.

Purpose of the Study:

  • To investigate sex-based differences in clinical and patient-reported outcomes (PROs) in rheumatoid arthritis (RA) over time.
  • To evaluate the impact of a treat-to-target (T2T) approach on RA management in female versus male patients.

Main Methods:

  • Analysis of 286 female and 139 male RA patients from the Treatment in the Rotterdam Early Arthritis Cohort (tREACH) trial.
  • Assessment of clinical outcomes including disease activity (DAS44), medication usage (DMARDs, bDMARDs), sustained DMARD-free remission (SDFR), and radiographic progression.
  • Evaluation of PROs such as general health, pain, functional ability (HAQ-DI), quality of life, fatigue, productivity loss, and mental health, using mixed models adjusted for confounders.

Main Results:

  • Female RA patients exhibited higher DAS44 scores over time (β=0.36, P<0.001) and increased need for bDMARDs (36% vs 24%, P<0.001).
  • No significant differences were observed in SDFR or radiographic progression between sexes.
  • Functional ability, measured by HAQ-DI, was significantly worse in females (β=0.10, P<0.001) after adjusting for confounders.

Conclusions:

  • Despite a T2T approach improving outcomes, female RA patients demonstrate higher disease activity and functional impairment.
  • Females require more bDMARDs, which appear to have lower efficacy.
  • These sex-specific differences underscore the necessity for tailored management recommendations in rheumatoid arthritis.