Sex Differences in Rheumatoid Arthritis: New Insights From Clinical and Patient-Reported Outcome Perspectives.

IF 3.6 2区 医学 Q2 RHEUMATOLOGY
Gonul Hazal Koc, Agnes E M Looijen, Irene E van der Horst-Bruinsma, Pascal H P de Jong
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Abstract

Objective: The disease course and burden of rheumatoid arthritis (RA) may differ between female and male individuals, but existing data on these differences are limited and often contradictory. Therefore, we investigated whether clinical outcomes and patient-reported outcomes (PROs) differ between female and male patients with RA over time.

Methods: All female (n = 286) and male (n = 139) patients with RA according to 1987 and/or 2010 criteria from Treatment in the Rotterdam Early Arthritis Cohort (tREACH), a stratified single-blinded trial with a treat-to-target (T2T) approach and fixed medication protocol, were included. Clinical outcomes include disease activity, medication usage, sustained disease-modifying antirheumatic drug (DMARD)-free remission (SDFR), and radiographic progression. In addition, the following PROs were investigated: general health, pain, functional ability, health-related quality of life, fatigue, productivity loss, and a possible depression or anxiety disorder. For comparisons over time, a mixed model or Cox proportional hazard model was used. The mixed models were adjusted for age, initial treatment, and disease activity (Disease Activity Score in 44 joints [DAS44]).

Results: Female patients had a higher DAS44 over time compared to male patients (β 0.36, 95% CI 0.25-0.47, P < 0.001), which also resulted in more treatment adjustments including use of biologic DMARDs (bDMARDs; 36% vs 24%, P < 0.001). Although not significant, first bDMARD survival seemed shorter in female patients (hazard ratio [HR] 1.4, 95% CI 0.8-2.6, P = 0.24). However, no differences were found in SDFR and radiographic progression. With regard to PROs, only functional ability differed significantly between sexes after adjusting for confounders, including disease activity (Health Assessment Questionnaire-Disability Index, β 0.10, 95% CI 0.04-0.17, P < 0.001).

Conclusion: Clinical outcomes and PROs are intertwined, and both improve with a T2T management approach. Nevertheless, female patients with RA have higher disease activity, a greater need for bDMARDs-although these have lower efficacy-and more functional impairment over time, underscoring the need for sex-specific management recommendations. (Trial registration number: ISRCTN26791028).

类风湿关节炎的性别差异:从临床和患者报告结果角度的新见解。
目的:类风湿性关节炎(RA)的病程和负担在女性和男性之间可能存在差异,但现有的这些差异的数据是有限的,往往是相互矛盾的。因此,我们调查了女性和男性RA患者的临床结局和患者报告的结局(PROs)是否随时间而不同。方法:所有女性(n=286)和男性(n=139) RA患者,根据1987年和/或2010年标准,来自tREACH试验,一项分层单盲试验,采用治疗到目标方法和固定用药方案。临床结果包括疾病活动性、药物使用、持续无dmard缓解(sDFR)和放射学进展。此外,还调查了以下PROs:一般健康状况、疼痛、功能能力、(与健康相关的)生活质量、疲劳、生产力下降以及可能的抑郁或焦虑障碍。对于随时间的比较,使用混合模型或Cox比例风险模型。混合模型根据年龄、初始治疗和疾病活动性(DAS44)进行调整。结果:随着时间的推移,女性的DAS44比男性高(β=0.36(95%CI:0.25-0.47))。结论:临床结果和PROs相互交织,两者都随着治疗到目标的管理方法而改善。然而,女性类风湿性关节炎患者的疾病活动性更高,对疗效较差的生物制剂的需求更大,随着时间的推移,功能损害更大,这强调了针对性别的管理建议的必要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Rheumatology
Journal of Rheumatology 医学-风湿病学
CiteScore
6.50
自引率
5.10%
发文量
285
审稿时长
1 months
期刊介绍: The Journal of Rheumatology is a monthly international serial edited by Earl D. Silverman. The Journal features research articles on clinical subjects from scientists working in rheumatology and related fields, as well as proceedings of meetings as supplements to regular issues. Highlights of our 41 years serving Rheumatology include: groundbreaking and provocative editorials such as "Inverting the Pyramid," renowned Pediatric Rheumatology, proceedings of OMERACT and the Canadian Rheumatology Association, Cochrane Musculoskeletal Reviews, and supplements on emerging therapies.
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