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Do women have more severe arthritis, or are we just more open about it?

by  Christine Miller 
Monday, January 19, 2009

            Do women really have more severe arthritis than men?  Are we more open or honest when answering questionnaires?  Or are we just more likely to complain?  Those are the questions raised for me by a research study published in the January issue of Arthritis Research and Therapy (and the many subsequent news articles written this week).

            It's long been known that more women develop RA than men, in fact, 70% of people with RA are women.  Other gender differences have also been noted.  Both men and women have relatively equal disease activity (number of joints affected), damage to joint structure and deformities.  However, while men generally have a higher incidence of rheumatoid nodules, higher mortality rates, and are more likely to be RF positive; women generally are more likely to have RA, have more severe symptoms, higher erythrocyte sedimentation (ESR) rates and report greater rates of functional disability and work disability.  Other studies have found that men are more likely to have periods of remission.  Men have also been shown to have higher response rates to biologic drugs; but on the other hand, they also have higher rates of adverse events and serious infections with those drugs. 

            In the current study, researchers from Finland reviewed data from over 6,000 people from 25 countries around the world.  Their research found that even though women reported the same level of disease as men, they reported more severe disease symptoms than the male participants.  Women were more likely to report pain, aches, tiredness, depression and other symptoms.

            Interestingly, the researchers attributed these results to the fact that men are physically stronger and have more muscle mass than women.  But what does joint tenderness and inflammation have to do with body strength?  Wouldn't the severity of disease or level of disability be relative to each person?  The researchers referred to women as "the weaker vessel" and determined that because women's baseline strength and other values are lower than men's, that the same burden of a musculoskeletal disease may appear to be more severe in women than in men.  

            I admit, at first I was offended by this conclusion.  At least, I was offended by the way it was phrased in several of the news articles.  However, the researchers also said that the results that seem to show more severe symptoms in women may be a function of the evaluation tools.  Currently, the tools evaluate men and women the same way.  If women begin with a disadvantage, then the results may be skewed to appear that women have more severe symptoms than men.  So perhaps researchers need to develop a relative tool that could more accurately reflect disease severity for men and women. 

            Another theory for the discrepancy in the scores is that men women may just be more open and willing to admit to difficulties on self-report evaluations.  Perhaps women are more likely to recognize the symptoms or to admit to having depression.  Maybe men, whether consciously or unconsciously, play down symptoms or disabilities. 

            Or maybe women really do suffer from more severe RA symptoms than men?  It has been well established that women's hormones play a factor in the disease process.  Women are much more likely than men to develop RA, but that disparity decreases greatly for post-menopausal women.  Women also experience decreased disease activity and symptoms during pregnancy commonly followed by a resurgence of the disease after delivery.  Perhaps the fact that women consistently report worse symptoms and more severe disease is not explained by difference in physical strength or a penchant for complaining. 

            What do you think?  Men- do women suffer more and are men less likely to acknowledge symptoms to their physicians or family or while taking evaluations?  Women- do you really think we suffer more than men or are we more likely to discuss it or complain about it openly?  Or do you think these results are a function of a one-size-fits-all method of evaluating RA?  Are our disease courses and experiences relative to our baseline gender differences?

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