“Some of the gender differences in severity of RA at diagnosis may be that men tend to ignore or discount their symptoms for a longer period of time than women,” says Dr. Felson. “They continue to work jobs that are more destructive to the joint and do a lot of damage until the pain gets to be excessive. Then they initially present to the doctor with more advanced disease.”
However, is this advanced disease related to the gender or the behavior?
Hormonal Influences?
“For some diseases, such as RA and lupus, hormonal differences may prove to be important, although their specific roles are not known despite a lot of investigation,” says Dr. Felson. “These effects probably will vary by disease and hormone. Studying hormones and their effects on immune responses may provide us with insights into why the manifestations of some diseases are different between genders. It may also provide clues to better treatments.”
It is also well established that there are anatomical and physiological differences between the two sexes. How these may affect severity, presentation, and treatment is still the subject of controversy.
Roles for Anatomy and Physiology
“The normal anatomical differences between men and women can make the consequences of rheumatoid diseases more significant in the female,” says Dr. van Vollenhoven. “One example is the fact that women in general have a lower bone density than men. RA may aggravate the natural decline of bone density with age and some of the treatments for RA will add to this decline. Because the female patient starts out with a lower bone density than males, the consequences may become more serious in the former.”
Differences in physiology are another area that some of the experts find especially interesting. “One of the clues in AS may be gender-related changes in the lymphatic system,” says Dr. Lockshin. “Men and women have different drainage systems in the pelvis. To the extent that AS may be induced by infections, this presents us with one possible explanation.”
In contrast to the well-established gender differences in the occurrence of rheumatic and autoimmune diseases, there is no evidence that men and women metabolize medications differently. While some cardiac drugs have been shown to be less efficacious in one gender, there are no similar examples among the classes of medications used in rheumatic or autoimmune diseases.
“There are, as of yet, no gender-specific treatments,” says Dr. van Vollenhoven. “On the other hand, there are obviously special issues for the female patients, because of the risks that drugs may have in terms of reproductive side effects and/or excretion into the breast milk with passage to the child during breastfeeding.”
