Abstract

BackgroundRheumatoid arthritis (RA), inflammatory bowel disease (IBD), and psoriasis are immune-mediated inflammatory diseases with similarities in pathophysiology, and all can be treated with similar biological agents. Previous studies have shown that there are gender differences with regard to disease characteristics in RA and IBD, with women generally having worse scores on pain and quality of life measurements. The relationship is less clear for psoriasis. Because treatment differences between men and women could explain the dissimilarities, we investigated gender differences in the disease characteristics before treatment initiation and in the biologic treatment prescribed.MethodsData on patients with RA or IBD were collected from two registries in which patients treated with biologic medication were enrolled. Basic demographic data and disease activity parameters were collected from a time point just before the initiation of the biologic treatment. For patients with psoriasis, the data were taken from the 2010 annual report of the Swedish Psoriasis Register for systemic treatment, which included also non-biologic treatment. For all three diseases, the prescribed treatment and disease characteristics were compared between men and women.ResultsIn total, 4493 adult patients were included in the study (1912 with RA, 131 with IBD, and 2450 with psoriasis). Most of the treated patients with RA were women, whereas most of the patients with IBD or psoriasis were men. There were no significant differences between men and women in the choice of biologics. At treatment start, significant gender differences were seen in the subjective disease measurements for both RA and psoriasis, with women having higher (that is, worse) scores than men. No differences in objective measurements were found for RA, but for psoriasis men had higher (that is, worse) scores for objective disease activity measures. A similar trend to RA was seen in IBD.ConclusionsWomen with RA or psoriasis scored significantly higher on subjective, but not on objective, disease activity measures than men, and the same trend was seen in IBD. This indicates that at the same level of treatment, the disease has a greater effect in women. These findings might suggest that in all three diseases, subjective measures are discounted to some extent in the therapeutic decision-making process, which could indicate undertreatment in female patients.

Highlights

  • Rheumatoid arthritis (RA), inflammatory bowel disease (IBD), and psoriasis are immune-mediated inflammatory diseases with similarities in pathophysiology, and all can be treated with similar biological agents

  • When biologic treatment was started for the first time in each patient, significant differences between men and women were found for erythrocyte sedimentation rate (ESR), patient global assessment, Tender joint count (TJC), Health Assessment Questionnaire (HAQ), Disease Activity Score with a 28-joint count (DAS28), and DAS28-C-reactive protein (CRP)

  • All these outcome values were higher in women than in men, with P-values ranging between 0.00 and 0.02

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Summary

Introduction

Rheumatoid arthritis (RA), inflammatory bowel disease (IBD), and psoriasis are immune-mediated inflammatory diseases with similarities in pathophysiology, and all can be treated with similar biological agents. In most studies focusing on the relationship between gender and RA, women were found to have higher disease activity scores, more pain and greater loss of function, both in early and established disease [3,4,5,6]. Other studies have reported faster progression of disability in women as measured by the Health Assessment Questionnaire (HAQ), and a lower remission rate in women with early RA [3,7]. These studies suggest a less favorable course in women, there is evidence to the contrary. Women underwent more surgical operations to correct the consequences of joint destruction [8]

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