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Rheumatology & immunology

Rheumatoid arthritis, men and women respond differently to therapies

January 1, 2018


Among the chronic inflammatory diseases, rheumatoid arthritis is the one that affects females the most. However, gender would not only be associated with a higher incidence of the disease: women and men tend to get different therapies and respond differently to these treatments. This is what researchers have investigated in a study presented at the last congress of the American College of Rheumatology. We talk about it with Professor Carlo Selmi, Head of Rheumatology and Clinical Immunology at Humanitas and lecturer at Milan University.


Arthritis and gender

Rheumatoid arthritis is a systemic disease that affects the synovium of the joints, in particular of hands and feet, but the inflammation extends to the whole body. Between the two genders, women are affected to a greater extent than men, with a ratio of about three to one. This is probably because female hormones play a decisive role in the onset and in the evolution of this pathology; therefore, the symptoms of rheumatoid arthritis can become much less intense with pregnancy.


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Furthermore, the pathology has a more precocious onset in females, and this is associated with a more severe clinical picture and a greater difficulty in achieving the stable remission of the disease. In other words, the symptoms tend to persist longer. Of course, the two most important reproductive events in a woman’s life, namely pregnancy and menopause, have a greater impact on the disease.


However, limiting the discourse on the difference between the two sexes, men seem to have a better response to treatments with anti-rheumatic drugs. For this reason, the treatment of rheumatoid arthritis is customised to the two categories of patients.


The research

The team of scientists, led by a researcher from Leiden University (Netherlands), analyzed data on a group of patients who had symptoms of rheumatoid arthritis for less than five years. The participants in the study were followed for at least three months in order to assess the impact of different treatments on the different degrees of disease activity.


First choice treatments for men and women tend to be different. The latter tent to have a worse response to therapy than men. However – the researchers conclude – in the case of therapy based on hydroxychloroquine, which is an anti-malarial drug used for rheumatoid arthritis and lupus, alone or in combination with other drugs, no significant differences emerged over time.

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