Abstract
Background. Rheumatoid arthritis (RA) epidemiology is characterised by the preference of the disease for women under age of 50, a sex ratio female:male of ≤ 3:1 being classically described, along with a peak for age onset between 50 and 75 years old. The relationship between female sexual hormons and susceptibility of rheumatoid arthritis is not completely understood and regional differences in the prevalence of the disease support the idea of environmental factors influence. Aim. To evaluate demographic features of patients with rheumatoid arthritis from South-East Romania, living in the climatic, economic and ethnic profile of Constanta county. Material and method. We included 447 patients (age≥18) with RA (ACR 1987 or ACR/EULAR 2010 diagnosis criteria) admitted in our Rheumatology Department – IInd Internal Medicine Clinic, Sf. Apostol Andrei Emergency Clinical County Hospital Constanta from January 2013 to December 2014. All patients agreed to participate in the study through an informed consent (approved by local ethical comittee) signed at admittion time. All patients underwent a careful clinical, biological and imagistic evaluation. Results. Our group of patients was a rheumatoid arthritis cohort with 88.4% Caucasian, 380 women (85%) and 67 men (15%), with a female-male ratio (F:M) of more than 5:1 (5.7:1), mean age of our patients was 62.13 ± 11.44 years and a mean age at onset of RA of 51.71±13.67 years, statistically different between men and women (p < 0.001). Sex distribution of rheumatoid arthritis varies with actual age of the patients, significant differences being observed in extreme age categories: < 40 years (F:M = 17:1) and > 70 years (F:M = 4.25:1), age at onset, with smoking status (F:M = 2:1), in early disease (F:M = 3.6:1). Conclusions. Female:Male ratio increases impresively in RA cases with early onset (<45 years), young man’s hormon constellation being probably a protective factor for the disease. Patients’ age, especially age at onset, seems to be the most important factor that influences sex distribution of rheumatoid arthritis.
Highlights
Rheumatoid arthritis (RA) epidemiology is characterised by the preference of the disease for women under age of 50, a sex ratio female: male of ≤ 3:1 being classically described, along with a peak for age onset between 50 and 75 years old [1]
The relationship between female sexual hormons and susceptibility of rheumatoid arthritis is not completely understood, it is demonstrated by the epidemiology of the disease and by other evidences, such as: high risk for RA in nulipar women, pregnancy – remission of the disease association, lower risk of RA in breastfeeding women [2]
We found similar percentages for women, more than 80%, in other clinical studies from Romania, which included unselected populations of patients with rheumatoid arthritis: 86.4% (Corina MogoŞan et al 2010, Bucuresti) [7], 90% (Denise Cristina Cosmescu et al 2009, Bucuresti) [8], 90% (Ioana Râcă et al 2012, Craiova) [9], 87,8% (Claudiu Popescu et al 2013, Bucuresti)(10), which means a female:male ratio similar to our study data
Summary
Rheumatoid arthritis (RA) epidemiology is characterised by the preference of the disease for women under age of 50, a sex ratio female:male of ≤ 3:1 being classically described, along with a peak for age onset between 50 and 75 years old. The relationship between female sexual hormons and susceptibility of rheumatoid arthritis is not completely understood and regional differences in the prevalence of the disease support the idea of environmental factors influence. Sex distribution of rheumatoid arthritis varies with actual age of the patients, significant differences being observed in extreme age categories: < 40 years (F:M = 17:1) and > 70 years (F:M = 4.25:1), age at onset, with smoking status (F:M = 2:1), in early disease (F:M = 3.6:1). Rheumatoid arthritis (RA) epidemiology is characterised by the preference of the disease for women under age of 50, a sex ratio female: male of ≤ 3:1 being classically described, along with a peak for age onset between 50 and 75 years old [1]. Regional differences in the prevalence of the disease support the idea of environmental factor influence (climatic conditions, industrialization and pollution, socio-economic status or life style that includes diet and smoking). In Europe, for example, a North-South gradient was identified, prevalence of ROMANIAN JOURNAL OF RHEUMATOLOGY – VOLUME XXIV, NO. 4, 2015
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