Tailoring Rheumatoid Arthritis Treatment through a Sex and Gender Lens

Abstract

Rheumatoid arthritis (RA) occurs more frequently in women than in men, and the studies that have addressed clinical and prognostic differences between the sexes are scarce and have contradictory results and methodological problems. The present work aims to evaluate sex- and gender-related differences in the clinical expression and prognosis of RA as well as on the impact on psychosocial variables, coping behavior, and healthcare use and access. By identifying between sex differences and gender-related outcomes in RA, it may be possible to design tailored therapeutic strategies that consider the differences and unmet needs. Being that sex, together with age, is the most relevant biomarker and health determinant, a so-called personalized medicine approach to RA must include clear guidance on what to do in case of differences.

The steroid-sparing effect of JAK inhibitors across multiple patient populations

“…Although it is well-known that comorbidities present a considerable burden for patients with RA or PsA and that sex and gender influence inflammatory arthritis manifestations and course, further studies would be helpful to assess factors predicting the response to JAK-i therapy (26-30). Literature data suggest that some comorbidities are more prevalent in the male population, such as cardiovascular and respiratory diseases and diabetes, while others like depression and osteoporosis are more prevalent in the female population (31). In our population, the prevalence of comorbidities in general was similar between men and women.…”

“…In our population, only 12 patients were of childbearing age; therefore, we did not analyze the differences in this particular reproductive age. Many studies suggest that a gender imbalance occurs only in subjective measures such as pain, functional status, and quality of life (31). Therefore, caution should be taken when a comparison is performed between male and female subjects since the fulfillment of the criteria to reach remission relies on patient-reported outcomes that may differ according to gender (35).…”

Comprehensive insights into rheumatoid arthritis: Pathophysiology, current therapies and herbal alternatives for effective disease management

“…In RA, decreasing oestrogen and progesterone levels during menopause might aid the pathogenesis of the disease since these hormones have anti-inflammatory and protective effects on bones and joints (Angum et al, 2020). The difference in the complex interactions between genes, environment and hormones may cause increased disease activity in women (Carmona et al, 2023). This is how gender plays a role in the risk of development and severity of disease manifestation.…”