A RECENT study highlighted significant sex-based differences in clinical and patient-reported outcomes (PROs) among patients with rheumatoid arthritis (RA), despite standardised treat-to-target (T2T) management.
Using data from the Rotterdam Early Arthritis Cohort (tREACH), the study analysed 286 female and 139 male patients over time. While both groups followed the same T2T strategy with a fixed medication protocol, female patients had persistently higher disease activity scores (DAS44; β 0.36, 95% CI 0.25–0.47, P < 0.001). This was associated with more frequent treatment escalations, including higher use of biologic DMARDs (36% in females vs 24% in males, P < 0.001). Though not statistically significant, bDMARD survival appeared shorter in females.
Importantly, sustained DMARD-free remission and radiographic progression did not differ by sex, suggesting similar long-term disease control. However, women reported worse functional ability over time, even after adjusting for disease activity (HAQ-DI β 0.10, 95% CI 0.04–0.17, P < 0.001). Other PROs, such as pain, fatigue, mental health, and productivity, showed no sex differences after adjustment.
The findings suggest that while a T2T approach benefits both sexes, it may not fully address the higher burden of disease experienced by female patients. The authors call for greater attention to sex-specific responses in RA management to optimise outcomes for all patients.
Aleksandra Zurowska, EMJ
Reference
Koc GH et al. Sex Differences in Rheumatoid Arthritis: New Insights From Clinical and Patient-Reported Outcome Perspectives. J Rheumatol. 2025;DOI: 10.3899/jrheum.2024-1258.
