Women, men, and rheumatoid arthritis: analyses of disease activity, disease characteristics, and treatments in the QUEST-RA study.
BACKGROUND
Gender as a predictor of outcomes of rheumatoid arthritis (RA) has evoked considerable interest over the decades. Historically, there is no consensus whether RA is worse in females or males. Recent reports suggest that females are less likely than males to achieve remission. Therefore, we aimed to study possible associations of gender and disease activity, disease characteristics, and treatments of RA in a large multinational cross-sectional cohort of patients with RA called Quantitative Standard Monitoring of Patients with RA (QUEST-RA).


METHODS
The cohort includes clinical and questionnaire data from patients who were seen in usual care, including 6,004 patients at 70 sites in 25 countries as of April 2008. Gender differences were analyzed for American College of Rheumatology Core Data Set measures of disease activity, DAS28 (disease activity score using 28 joint counts), fatigue, the presence of rheumatoid factor, nodules and erosions, and the current use of prednisone, methotrexate, and biologic agents.


RESULTS
Women had poorer scores than men in all Core Data Set measures. The mean values for females and males were swollen joint count-28 (SJC28) of 4.5 versus 3.8, tender joint count-28 of 6.9 versus 5.4, erythrocyte sedimentation rate of 30 versus 26, Health Assessment Questionnaire of 1.1 versus 0.8, visual analog scales for physician global estimate of 3.0 versus 2.5, pain of 4.3 versus 3.6, patient global status of 4.2 versus 3.7, DAS28 of 4.3 versus 3.8, and fatigue of 4.6 versus 3.7 (P < 0.001). However, effect sizes were small-medium and smallest (0.13) for SJC28. Among patients who had no or minimal disease activity (0 to 1) on SJC28, women had statistically significantly higher mean values compared with men in all other disease activity measures (P < 0.001) and met DAS28 remission less often than men. Rheumatoid factor was equally prevalent among genders. Men had nodules more often than women. Women had erosions more often than men, but the statistical significance was marginal. Similar proportions of females and males were taking different therapies.


CONCLUSIONS
In this large multinational cohort, RA disease activity measures appear to be worse in women than in men. However, most of the gender differences in RA disease activity may originate from the measures of disease activity rather than from RA disease activity itself.
Sokka
Tuulikki
T
Jyväskylä Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, and Medcare Oy, Hämeentie 1, 44100 Aänekoski, Finland. tuulikki.sokka@ksshp.fi
Toloza
Sergio
S
Cutolo
Maurizio
M
Kautiainen
Hannu
H
Makinen
Heidi
H
Gogus
Feride
F
Skakic
Vlado
V
Badsha
Humeira
H
Peets
Tõnu
T
Baranauskaite
Asta
A
Géher
Pál
P
Ujfalussy
Ilona
I
Skopouli
Fotini N
FN
Mavrommati
Maria
M
Alten
Rieke
R
Pohl
Christof
C
Sibilia
Jean
J
Stancati
Andrea
A
Salaffi
Fausto
F
Romanowski
Wojciech
W
Zarowny-Wierzbinska
Danuta
D
Henrohn
Dan
D
Bresnihan
Barry
B
Minnock
Patricia
P
Knudsen
Lene Surland
LS
Jacobs
Johannes Wg
JW
Calvo-Alen
Jaime
J
Lazovskis
Juris
J
Pinheiro
Geraldo da Rocha Castelar
Gda R
Karateev
Dmitry
D
Andersone
Daina
D
Rexhepi
Sylejman
S
Yazici
Yusuf
Y
Pincus
Theodore
T
D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D012737:Sex Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D018501:Antirheumatic Agents