Why Do Women with RA Start Treatment Later?

If there is one thing that makes us different from one another, it is our gender. For whatever reason, diseases can affect women differently than men. Doctors may need to consider this when choosing treatment.

Men and women with rheumatoid arthritis starting receiving anti-tumor necrosis factor (anti-TNF) treatment at the same point in the course of their disease as measured by their doctor.

However, when patients report their own disease activity, women receive anti-TNF treatment later in the course of their disease.

Ask your doctor about arthritis treatments.

In a recent study, Elizabeth V. Arkema, of Karolinska Institutet in Sweden, and colleagues wanted to see if men and women with rheumatoid arthritis were prescribed anti-TNF treatment at different levels of disease activity.

TNF is a substance in the body that promotes inflammation, a key characteristic of rheumatoid arthritis that causes joint pain and swelling. Anti-TNF therapies, or TNF inhibitors, are commonly used to treat rheumatoid arthritis.

According to the study's authors, "For women with rheumatoid arthritis, treatment with anti-TNF therapy was initiated at a higher level of subjective disease activity than for men, but at the same level of physician reported disease activity."

In other words, when they began anti-TNF treatment, both men and women had the same level of disease activity according to their doctor. However, according to their own measures, women started anti-TNF treatment at a higher level of disease activity than men.

More specifically, the researchers found that women were younger and had rheumatoid arthritis for a longer period of time than men when they started anti-TNF treatment.

The authors write that their findings suggest that doctors do not take patients' own experience of disease activity when making treatment decisions. 

At the time they started anti-TNF treatment, women had more tender joints, a higher erythrocyte sedimentation rate (a measure of inflammation), and higher levels of self-reported pain compared to men.

Men, on the other hand, had a higher level of C-reactive protein, another measure of inflammation. However, C-reactive protein counts can be affected by obesity - a factor doctors and scientists should take into account when assessing rheumatoid arthritis.

Both men and women had a similar number of swollen joints when they started anti-TNF treatment.

For their study, the researchers looked at data from ARTIS, a Swedish national biologics registry, to analyze different aspects of patients' disease at the start of anti-TNF treatment.

Their results are published in the Annals of the Rheumatic Diseases.