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The following is a summary of “Sex Differences in Rheumatoid Arthritis: New Insights From Clinical and Patient-Reported Outcome Perspectives,” published in the March 2025 issue of Journal of Rheumatology by Koc et al. 

Rheumatoid arthritis may progress differently in females and males, but data remain limited and conflicting. 

Researchers conducted a retrospective study to assess sex differences in clinical and patient-reported outcomes (PROs) in rheumatoid arthritis over time. 

They included 286 female and 139 male patients with RA from tREACH, a stratified single-blinded trial with a T2T approach. They assessed disease activity, medication use, SDFR, radiographic progression, and PROs, including pain, fatigue, and productivity loss. They used mixed or Cox proportional hazard models, adjusting for age, initial treatment, and DAS44. 

They included 286 female and 139 male patients with RA from the Treatment in the Rotterdam Early Arthritis Cohort (tREACH) trial, a stratified single-blinded study with a treat-to-target (T2T) approach. Clinical outcomes included disease activity, medication use, sustained disease-modifying antirheumatic drug (DMARD)-free remission (SDFR), and radiographic progression, while PROs covered pain, fatigue, and productivity loss. Mixed or Cox proportional hazard models were used, adjusting for age, initial treatment, and Disease Activity Score in 44 joints (DAS44). 

The results showed that female patients had a higher DAS44 over time (β 0.36, 95% CI 0.25-0.47, P < 0.001) and required more bDMARDs (36% vs 24%, P < 0.001). First bDMARD survival was shorter but not significant (hazard ratio [HR] 1.4, 95% CI 0.8-2.6, P = 0.24). SDFR and radiographic progression showed no differences. Only functional ability differed significantly after adjustment (HAQ-DI, β 0.10, 95% CI 0.04-0.17, P < 0.001). 

Investigators found that clinical outcomes and PROs improved with a T2T approach, but female patients had higher disease activity, greater bDMARD use with lower efficacy, and more functional impairment over time. 

Source:jrheum.org/content/early/2025/03/10/jrheum.2024-1258