Sex differences in rheumatoid arthritis: results of a cross-sectional study

Rheumatoid arthritis (RA) shows sex-related differences, but the expression across clinical domains remains inconsistent. We compared women and men with RA and explored characteristics associated with male sex.

This cross-sectional study included 240 adults with RA (160 women and 80 men). Demographic, clinical, laboratory, radiographic, treatment, and comorbidity data were compared by sex. An exploratory multivariable logistic regression model, with male sex coded as 1, was used to identify distinguishing characteristics.

Women were older and had higher body mass index, DAS28-CRP, pain, morning stiffness, and HAQ-DI scores. Men had a numerically shorter disease duration, but the difference was not statistically significant (7.46 vs 8.73 years; p = 0.158). CRP was higher in men (20.1 vs 14.1 mg/L; p = 0.003), whereas depression, fibromyalgia, hypertension, osteoporosis, and obesity were more frequent in women. Men more often received methotrexate; women more often received leflunomide, biologic therapy, and higher monthly glucocorticoid exposure. Radiographic erosion prevalence did not differ in the crude comparison. In the exploratory adjusted model, erosions were associated with male sex (aOR 1.78, 95% CI 1.15-3.20). Biologic therapy, higher HAQ-DI, older age, and higher body mass index were inversely associated with male sex. The DAS28-CRP score was not independently associated with sex after adjustment.

Women had greater symptomatic, functional, and comorbidity burdens, whereas men had higher CRP and an exploratory adjusted association with erosions. These findings highlight important sex-related differences in RA and support the need for sex-specific approaches to disease assessment and management.