Gender disparity in rheumatology clinical guidelines: "rheum" for improvement?

Although women now represent nearly half of the rheumatology workforce, gender disparities persist in academic leadership roles, including authorship of clinical guidelines. We evaluated gender representation trends over 2 decades in guideline authorship by the American College of Rheumatology (ACR) and the European Alliance of Associations for Rheumatology (EULAR), to assess progress and ongoing inequities.

We conducted a retrospective analysis of all available ACR (2008-2022) and EULAR (2001-2022) clinical guidelines on their respective websites. Author gender was determined using publicly available pronouns, professional profiles, and Gender API as a last resort. Chi-square tests assessed differences in gender representation between the first and second halves of the study period.

We identified 93 EULAR and 33 ACR guidelines, comprising 2169 and 982 authorship positions, respectively. Women filled 36.7% of EULAR and 48% of ACR authorship positions. Female representation increased significantly over time for both EULAR (20% to 41%, P < .0001) and ACR (34% to 53%, P < .0001). Among first authors, women represented 54% for EULAR and 52% for ACR guidelines. ACR showed a significant rise in female first authorship (25% to 66%, P = .02), whereas EULAR's increase was not statistically significant (48% to 57%, P = .42).

Although some disparities persist, there have been notable improvements in female first-author representation and overall inclusion in clinical guideline authorship. Given the female predominance among patients with rheumatic diseases, equitable representation among guideline authors is essential for inclusive and reflective clinical recommendations. Structural reforms and mentorship initiatives are necessary to ensure lasting equity in academic rheumatology.