Women, men, and rheumatoid arthritis: analyses of disease activity, disease characteristics, and treatments in the QUEST-RA Study
Authors: Sokka Tuulikki , Toloza Sergio , Cutolo Maurizio , Kautiainen Hannu , Makinen Heidi , Gogus Feride , Skakic Vlado , Badsha Humeira , Peets Tõnu , Baranauskaite Asta , Géher Pál , Újfalussy Ilona , Skopouli Fotini N , Mavrommati Maria , Alten Rieke , Pohl Christof , Sibilia Jean , Stancati Andrea , Salaffi Fausto , Romanowski Wojciech , Zarowny-Wierzbinska Danuta , Henrohn Dan , Bresnihan Barry , Minnock Patricia , Knudsen Lene Surland , Jacobs Johannes WG , Calvo-Alen Jaime , Lazovskis Juris , Pinheiro Geraldo da Rocha Castelar , Karateev Dmitry , Andersone Daina , Rexhepi Sylejman , Yazici Yusuf , Pincus Theodore ,   the QUEST-RA Group
Published: January 2009

Abstract
Introduction
Gender as a predictor of outcomes of rheumatoid arthritis (RA) has evoked considerable interest over the decades. Historically, there is no consensus whether RA is worse in females or males. Recent reports suggest that females are less likely than males to achieve remission. Therefore, we aimed to study possible associations of gender and disease activity, disease characteristics, and treatments of RA in a large multinational cross-sectional cohort of patients with RA called Quantitative Standard Monitoring of Patients with RA (QUEST-RA).

Methods
The cohort includes clinical and questionnaire data from patients who were seen in usual care, including 6,004 patients at 70 sites in 25 countries as of April 2008. Gender differences were analyzed for American College of Rheumatology Core Data Set measures of disease activity, DAS28 (disease activity score using 28 joint counts), fatigue, the presence of rheumatoid factor, nodules and erosions, and the current use of prednisone, methotrexate, and biologic agents.

Results
Women had poorer scores than men in all Core Data Set measures. The mean values for females and males were swollen joint count-28 (SJC28) of 4.5 versus 3.8, tender joint count-28 of 6.9 versus 5.4, erythrocyte sedimentation rate of 30 versus 26, Health Assessment Questionnaire of 1.1 versus 0.8, visual analog scales for physician global estimate of 3.0 versus 2.5, pain of 4.3 versus 3.6, patient global status of 4.2 versus 3.7, DAS28 of 4.3 versus 3.8, and fatigue of 4.6 versus 3.7 (P < 0.001). However, effect sizes were small-medium and smallest (0.13) for SJC28. Among patients who had no or minimal disease activity (0 to 1) on SJC28, women had statistically significantly higher mean values compared with men in all other disease activity measures (P < 0.001) and met DAS28 remission less often than men. Rheumatoid factor was equally prevalent among genders. Men had nodules more often than women. Women had erosions more often than men, but the statistical significance was marginal. Similar proportions of females and males were taking different therapies.

Conclusions
In this large multinational cohort, RA disease activity measures appear to be worse in women than in men. However, most of the gender differences in RA disease activity may originate from the measures of disease activity rather than from RA disease activity itself.