Doctor... Does Gender Play a Role in the Prognosis of Rheumatoid Arthritis?

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Women with rheumatoid arthritis (RA) have significantly less chance of remission than men, finds research published in the Annals of the Rheumatic Diseases. This appears in an online report published in December 2006.

The authors based their findings on approximately 700 adults who had been recently diagnosed with rheumatoid arthritis.

Their average age was 58, and they had had their disease for an average of six months. Two thirds of study participants were women, and they tended to be younger than the men.

After two years, the disease had gone into remission in just under four out of 10 study participants. After five years, the proportion in remission was similar, at 38.5%. But only around one in five were in remission at both time points.

Gender was a significant factor in the progress of the disease. At two years, just under a third of the women (32%) were in remission compared with almost half of the men (48%).

By five years, the gap had widened, with just under 31% of women in remission compared with 52% of the men.

Men were more than twice as likely to be in remission as women at both time points.

Women did not have more severe disease than the men initially, but it quickly became more severe and progressed more rapidly than it did among the men.

Differences in how long a person had had the disease, their age, or their drug treatment could not explain the discrepancy in remission rate, say the authors.

This gender difference for chance of remission is disturbing enough.

However, another potentially major issue is the marked increased incidence of cardiovascular events described in women with RA. Women with rheumatoid arthritis have high rates of non fatal heart attacks. This occurs even without traditional risk factors being present. (Solomon, et al. Circulation 2003; 107: 1303-1307). This complication adds to the concern regarding the long term prognosis of RA occurring in women.

There is some good news though. This study reports data from a large population of patients who experienced disease for a significant amount of time before the advent and use of the newer biologic therapies. It is quite possible that these drugs will change these statistics for the better. The ability to induce remission in both genders has improved dramatically.

Nathan Wei, MD, FACP, FACR is a rheumatologist and Director of the Arthritis and Osteoporosis Center of Maryland (http://www.aocm.org). He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine and consultant to the National Institutes of Health. For more info: Arthritis Treatment