Considering these factors, language used to describe outcomes in rheumatic disease may need modification as well as a new conceptualization. Thus, the phrase “Male sex—a major predictor of remission” might be more accurately stated as “Male sex—a major predictor of meeting remission criteria.”49 Furthermore, in trying to convey better male–female differences in the course of RA, it is important to consider that disease-activity measures, especially in the setting of low disease activity near remission, behave differently in men than in women; there are nevertheless exceptions.50
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Explore This IssueDecember 2009
Therefore, one may pose the question of whether we need new criteria for remission that treat men and women separately. Certainly, the current criteria sets used for RA remission vary in stringency, thereby affecting the percentage of patients achieving a level of disease activity operationally defined as remission. Among the criteria sets, the level of activity defining remission may vary depending on the number of factors assessed, the weighting, and even the number of joints assessed. Therefore, in populations of patients, remission rates have to be interpreted in light of the definition that has been used for remission. In case of an individual patient, however, whether a man or a woman, “we recognize it (remission) when we see it,” according to a wise suggestion by Paulus.51
Data and beliefs exert powerful influences on science and medicine and affect the way we think and the way we act. Rheumatology is no different than other specialties, although, when it comes to the matter of sex, beliefs may have trumped data. From my reading of the data, I would conclude that, despite some differences in the measures of disease activity, RA is essentially the same disease in women and men. Furthermore, anyone who has read this article to this point may conclude that news concerning differences in disease course between women and men, like everything else having to do with sex, can attract attention. Now that I have your attention, I hope that you will look at the data.
Acknowledgement: This article is based in part on data presented in Sokka T, et al. Arthritis Res Ther. 2009; 11(1):R7.
Dr. Sokka is a rheumatologist at the Jyväskylä Central Hospital in Jyväskylä, Finland.
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