Rheumatoid Arthritis Takes Greater Toll on Women

by Jennifer Wider, M.D.

(Washington DC):  Women who suffer from early rheumatoid arthritis (RA) seem to experience functional deterioration more rapidly than men according to a new study in the July 2003 issue of the Annals of the Rheumatic Diseases. Despite improvement in disease activity following medical treatment, more women than men noticed a decrease in their functional abilities. 

Dr. Thomas Skogh, Professor of Rheumatology at the Linkoping University Hospital in Sweden and a team of researchers examined 284 patients with recent onset rheumatoid arthritis. The patients were followed for two years from the time of the initial diagnosis. The researchers measured the extent of the disease using a variety of factors including range of motion, walking time and a grading system for well-being and pain. Patients were also given a self-assessment to judge their ability to function. They examined changes over time and differences between men and women.

Despite the fact that medication helped control joint damage in both genders, women were unable to function as well as men after 1-2 years. "In individual cases it is not possible to generalize, but on the whole, women have a more aggressive disease course than men," explains Dr. Skogh, the lead researcher of the study.

Rheumatoid arthritis is one of the most common forms of arthritis, affecting 2.1 million Americans, mostly women, according to data from the Arthritis Foundation. It is an autoimmune disease that involves the immune system attacking joint tissue which results in inflammation and permanent joint damage. The most common symptoms include: inflammation of the joints, swelling, difficulty moving and pain. Patients often experience pain and swelling of the same joints on both sides of the body. It usually starts in the hands or feet. Patients can also develop lumps or rheumatoid nodules under the skin.

"An important thing is to diagnose patients (both women and men) with rheumatoid arthritis as early as possible and to rapidly institute disease-modifying anti-rheumatic drugs (DMARDs) early in the disease," explains Dr. Skogh. Studies have shown that if patients are treated early with this class of disease-modifying drugs, their conditions can be controlled in many cases.

The cause of rheumatoid arthritis is unknown. Studies have shown that a person's genetic make-up may play a role. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, certain people with rheumatoid arthritis have express genes which play a role in the immune response and are associated with the development of the disease. Yet other people who do not have express these particular genes still develop rheumatoid arthritis. More studies are needed to explore this phenomenon, but it suggests that genetic factors may play a role (redundant due to the first sentence). Other studies have explored the role of environmental factors and hormonal factors. Because many more women are affected by the disease, hormonal influences are likely to be involved. Most studies agree that the development of rheumatoid arthritis depends on the interplay of several factors.

Scientists have tried to uncover potential behavioral risk factors in the development of rheumatoid arthritis. Certain studies point to cigarette smoking and the use of hair-dyes, but the results have been inconclusive. According to Dr. Skogh, "No single factor can be pointed out. It is not yet possible to give general recommendations to patients."

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The Society for Women's Health Research is the nation's only not-for-profit organization whose sole mission is to improve the health of women through research. Founded in 1990, the Society brought to national attention the need for the appropriate inclusion of women in major medical research studies and the resulting need for more information about conditions affecting women. The Society advocates increased funding for research on women's health, encourages the study of sex differences that may affect the prevention, diagnosis and treatment of disease, and promotes the inclusion of women in medical research studies. Dr. Donnica Moore has been a member of the Society since 1990 and is a past member of its Board of Directors.

Created: 8/7/2003  -  Jennifer Wider, M.D.
Reviewed: 8/7/2003  -  Donnica Moore, M.D.