Focus on Sex and Gender: What We Need to Know in the Management of Rheumatoid Arthritis

Abstract

Rheumatoid arthritis (RA) is a chronic inflammatory disease, affecting mostly women with a female/male ratio of 3:1. It is characterized by symmetrical polyarthritis, leading to progressive joint damage. Sex differences have been reported in terms of disease course and characteristics, influencing patients reported outcome measures (PROMs) and pain perception, ultimately leading to male-female disparities in treatment response. Notwithstanding, sex and gender discrepancies are still under-reported in clinical trials. Therefore, there is a consistent need for a precise reference of sex and gender issues in RA studies to improve treat-to-target achievement. This narrative review explores the above-mentioned aspects of RA disease, discussing the latest core principles of RA recommendations, from safety issues to early arthritis concept and management, treat-to-target and difficult-to-treat notions, up to the most recent debate on vaccination. Our final purpose is to evaluate how sex and gender can impact current management guidelines and how this issue can be integrated for effective disease control.

Keywords: clinimetrics; gender; guidelines; immune response; rheumatoid arthritis; sex; treat-to-target; treatments.

Figure 1

Overview of key principles of RA management from the latest sets of recommendations: both sex- and gender-based factors contribute to the illustrated aspects, affecting clinical response and outcome between females and males and, therefore, should be considered in biomedical research. Abbreviations: ADA = anti-drug antibody; D2T = difficult-to-treat; NIRRA = non-inflammatory refractory RA; T2T = treat-to-target.