Gender and the treatment of immune-mediated chronic inflammatory diseases: rheumatoid arthritis, inflammatory bowel disease and psoriasis: an observational study

BMC Medicine

Research Article

Ragnar Befrits¹  Nienke Lesuis²  Ronald F van Vollenhoven³  Filippa Nyberg⁴ 

[1] Gastrocentrum Medicin, Karolinska University Hospital, 17176, Stockholm, Sweden;Medical Faculty, Radboud University, Geert Grooteplein 21, 6500, Nijmegen, HB, The Netherlands;Rheumatology Department, Sint Maartenskliniek, Hengstdal 3, 6500, Nijmegen, GM, The Netherlands;Unit for Clinical Therapy Research Inflammatory Diseases (ClinTRID), The Karolinska Institut, D10:0, 17176, Stockholm, Sweden;Uppsala University Hospital, Uppsala, and Unit for dermatology, Institution for clinical sciences, Karolinska Institutet, Danderyd hospital, SE-182 88, Stockholm, Sweden;

关键词: Rheumatoid Arthritis;    Inflammatory Bowel Disease;    Psoriasis;    Infliximab;    Health Assessment Questionnaire;   

DOI  :  10.1186/1741-7015-10-82

 received in 2012-01-14, accepted in 2012-08-01,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundRheumatoid arthritis (RA), inflammatory bowel disease (IBD), and psoriasis are immune-mediated inflammatory diseases with similarities in pathophysiology, and all can be treated with similar biological agents. Previous studies have shown that there are gender differences with regard to disease characteristics in RA and IBD, with women generally having worse scores on pain and quality of life measurements. The relationship is less clear for psoriasis. Because treatment differences between men and women could explain the dissimilarities, we investigated gender differences in the disease characteristics before treatment initiation and in the biologic treatment prescribed.MethodsData on patients with RA or IBD were collected from two registries in which patients treated with biologic medication were enrolled. Basic demographic data and disease activity parameters were collected from a time point just before the initiation of the biologic treatment. For patients with psoriasis, the data were taken from the 2010 annual report of the Swedish Psoriasis Register for systemic treatment, which included also non-biologic treatment. For all three diseases, the prescribed treatment and disease characteristics were compared between men and women.ResultsIn total, 4493 adult patients were included in the study (1912 with RA, 131 with IBD, and 2450 with psoriasis). Most of the treated patients with RA were women, whereas most of the patients with IBD or psoriasis were men. There were no significant differences between men and women in the choice of biologics. At treatment start, significant gender differences were seen in the subjective disease measurements for both RA and psoriasis, with women having higher (that is, worse) scores than men. No differences in objective measurements were found for RA, but for psoriasis men had higher (that is, worse) scores for objective disease activity measures. A similar trend to RA was seen in IBD.ConclusionsWomen with RA or psoriasis scored significantly higher on subjective, but not on objective, disease activity measures than men, and the same trend was seen in IBD. This indicates that at the same level of treatment, the disease has a greater effect in women. These findings might suggest that in all three diseases, subjective measures are discounted to some extent in the therapeutic decision-making process, which could indicate undertreatment in female patients.

【 授权许可】

CC BY   
© Lesuis et al; licensee BioMed Central Ltd. 2012