title: Women, men, and rheumatoid arthritis: analyses of disease activity, disease characteristics, and treatments in the QUEST-RA study.
abstract: 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.
authors.affiliation: Jyväskylä Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, and Medcare Oy, Hämeentie 1, 44100 Aänekoski, Finland. tuulikki.sokka@ksshp.fi
authors.forename: Tuulikki
authors.initials: T
authors.lastname: Sokka
authors.forename: Sergio
authors.initials: S
authors.lastname: Toloza
authors.forename: Maurizio
authors.initials: M
authors.lastname: Cutolo
authors.forename: Hannu
authors.initials: H
authors.lastname: Kautiainen
authors.forename: Heidi
authors.initials: H
authors.lastname: Makinen
authors.forename: Feride
authors.initials: F
authors.lastname: Gogus
authors.forename: Vlado
authors.initials: V
authors.lastname: Skakic
authors.forename: Humeira
authors.initials: H
authors.lastname: Badsha
authors.forename: Tõnu
authors.initials: T
authors.lastname: Peets
authors.forename: Asta
authors.initials: A
authors.lastname: Baranauskaite
authors.forename: Pál
authors.initials: P
authors.lastname: Géher
authors.forename: Ilona
authors.initials: I
authors.lastname: Ujfalussy
authors.forename: Fotini N
authors.initials: FN
authors.lastname: Skopouli
authors.forename: Maria
authors.initials: M
authors.lastname: Mavrommati
authors.forename: Rieke
authors.initials: R
authors.lastname: Alten
authors.forename: Christof
authors.initials: C
authors.lastname: Pohl
authors.forename: Jean
authors.initials: J
authors.lastname: Sibilia
authors.forename: Andrea
authors.initials: A
authors.lastname: Stancati
authors.forename: Fausto
authors.initials: F
authors.lastname: Salaffi
authors.forename: Wojciech
authors.initials: W
authors.lastname: Romanowski
authors.forename: Danuta
authors.initials: D
authors.lastname: Zarowny-Wierzbinska
authors.forename: Dan
authors.initials: D
authors.lastname: Henrohn
authors.forename: Barry
authors.initials: B
authors.lastname: Bresnihan
authors.forename: Patricia
authors.initials: P
authors.lastname: Minnock
authors.forename: Lene Surland
authors.initials: LS
authors.lastname: Knudsen
authors.forename: Johannes Wg
authors.initials: JW
authors.lastname: Jacobs
authors.forename: Jaime
authors.initials: J
authors.lastname: Calvo-Alen
authors.forename: Juris
authors.initials: J
authors.lastname: Lazovskis
authors.forename: Geraldo da Rocha Castelar
authors.initials: Gda R
authors.lastname: Pinheiro
authors.forename: Dmitry
authors.initials: D
authors.lastname: Karateev
authors.forename: Daina
authors.initials: D
authors.lastname: Andersone
authors.forename: Sylejman
authors.initials: S
authors.lastname: Rexhepi
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Yazici
authors.forename: Theodore
authors.initials: T
authors.lastname: Pincus
mesh_terms: 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
chemical_list: D018501:Antirheumatic Agents