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Sex Differences Found in Remission Course for Rheumatoid Arthritis Patients

The median time-to-remission was longer for women compared to men.

Men with rheumatoid arthritis are more likely to have shorter times to remission compared to women.

A team, led by Orit Schieir, McGill University, compared early and sustained remission in men and women patients with early rheumatoid arthritis receiving guideline-based care in rheumatology clinics in Canada.

The data was presented during the 2022 American College of Rheumatology (ACR) Convergence Meeting in Philadelphia.

Sex Differences in Studies

Oftentimes, historical and established rheumatoid arthritis studies have identified sex disparities in remission outcomes favoring male patients.

In the study, the investigators examined data from the Canadian Early Arthritis Cohort (CATCH), a multi-center inception cohort of ERA patients, between 2007-2019.

The study included 2743 patients with ERA, 1933 of which were women. The mean SDAI score at baseline was 27.4 and the majority of patients (92%) were treated with csDMARDs. This generally included MTX, either as a monotherapy or in combination with csDMARDs (77%). Finally, 29% of patients were treated with oral steroids.

Each participant had symptoms for less than a year, while 83% met the rheumatoid arthritis criteria at enrollment and completed standardized study visits, which included detailed rheumatoid arthritis clinical assessments, patient-reported outcomes, and laboratory investigations every 3 months in the first year, every 6 months in the second year, and annually for the remainder of the study. This mirrored real-world care practices in Canada.

The treatment decisions were at the discretion of the treating rheumatologist.

The investigators used descriptive statistics to summarize and compare the prevalence of SDAI remission (< 3.3.), median time to SDAI remission and sustained SDAI remission 12- and 24- months after first remission across men and women.

They also used multinomial regression to identify predictors of minor flares (SDAI REM→LDA) and major flares (SDAI REM→MDA/HDA) over 24-months follow-up from first remission.

Similiarities and Differences

There were no significant differences in disease activity or treatment strategies found between men and women at enrollment.

The prevalence of SDAI remission over the course of follow-up was similar between the 2 groups (men: 64%; women: 61%). However, the median time-to-remission was longer for women compared to men (19.2 months vs 16.1 months, P = 0.0358).

There was also a lower proportion of women compared to men who reached early remission targets by 12-months (37% vs 43%; P = 0.0054).

Sustained remission at 12 and 24 months after the first remission was also higher in men and predictors of minor and major flares after remission also differed by sex. For example smoking, seropositivity, and residual disability at first SDAI remission were considered predictors for men, while obesity, comorbidities, and higher SDAI at first remission were predictors for women.

Finally, advanced therapy treatment at first remission was linked to a lower likelihood of flares after remission in women.

“Results of this large longitudinal study of ERA patients receiving contemporary guideline-based care showed high overall rates of SDAI remission for men and women over the study period, however there were notable sex differences favoring men in the rapidity and sustainability of remission,” the authors wrote. “Predictors of minor and major flares after remission also differed between men and women and highlighted potential modifiable risk factors for sustaining remission over longer periods including smoking and residual disability at remission in men, and obesity and chronic comorbidity management in women.”

The study, “Women with Early Rheumatoid Arthritis Less Likely to Achieve Rapid and Sustainable Remission: Results from the Canadian Early Arthritis Cohort Study,” was published online by ACR Convergence.

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https://www.rheumatologynetwork.com/conferences/acr