Women eat healthier, visit their doctors more often and take advantage of preventive services more frequently than men. Nevertheless, you receive the diagnosis about a rheumatic disease much later. This is despite the fact that they are more likely to suffer from rheumatism and report an increased disease burden compared to male patients. These are the findings of a recent survey study on gender-specific differences in the diagnosis and treatment of rheumatic diseases.
In the majority of rheumatic diseases, the proportion of women affected is greater than that of men. This mainly concerns collagenoses and rheumatoid arthritis. In spondyloarthritides, the gender distribution is balanced. Only a few inflammatory rheumatic diseases, such as Behcet’s disease, affect men more frequently. “It seems all the more surprising that women receive a diagnosis significantly later on average,” says private lecturer Dr. med. Uta Kiltz, senior physician at the Rheumazentrum Ruhrgebiet. A possible reason for this could be that the course of the disease is usually more severe in men. Therefore, damage to organs shows up earlier and is more likely to indicate a rheumatic disease. Also – as in the example of systemic sclerosis – certain markers and antibodies form earlier in the blood of men. “In addition, women present a more diverse picture of symptoms, which can further complicate a definitive diagnosis,” Kiltz explains. These differences can be attributed to hormonal, immunological and (epi)genetic differences, among others. A Canadian analysis also revealed that male primary care physicians initiated a rheumatology referral later than their female colleagues, regardless of patient gender. Consequently, the gender of the treating physicians may also contribute to differences in care.
Whether the efficacy of medications differs between the sexes is a matter of debate. It has been shown that immunosuppressive therapies have a less durable effect in women and that they are significantly less likely to achieve the therapeutic goal of low disease activity compared with men. One reason for this could be that women rate disease activity higher than men in self-report. In addition, rheumatic diseases can have social and psychological consequences that affect men and women differently. This is also related to differences in societal expectations and role models. “This is where we are at the very beginning: there is still a significant need for research to understand contextual factors to the point where personalized medicine is possible,” Kiltz explains.
“The results show that rheumatology has some catching up to do in this area. We need to better understand the gender-specific manifestations of the disease and incorporate these findings into diagnostics and therapy,” also emphasizes Professor Christoph Baerwald, MD, PhD, Congress President of the DGRh and Head Emeritus of the Department of Rheumatology at Leipzig University Hospital.
Original publication:
Katinka Albrecht & Anja Strangfeld: Gender-specific differences in diagnosis and therapy of inflammatory rheumatic diseases.
Die Innere Medizin volume 64, pages 744-751 (2023); Gender differences in diagnosis and therapy of inflammatory rheumatic diseases | SpringerLink
