Rheumatoid Arthritis Poses Special Challenge to Men

Rheumatoid arthritis poses a challenge to the masculinity of men who have it, and they often cope by hiding their disease in public.

Men often forgo speaking to friends about their rheumatoid arthritis, thinking they will not understand.

Men with rheumatoid arthritis sometimes use destructive, possibly disease exacerbating behaviors to cope with the disease.

Men with rheumatoid arthritis frequently are reluctant to speak with their health care team about emotional issues unless they are asked about them.

Caroline Flurey at the University of West England, Bristol, UK and fellow researchers pointed out that in addition to there being a preponderance of women who have rheumatoid arthritis, the course, symptoms, and perceptions of the disease may differ for men. A thorough literature review has revealed no consensus on whether a patient’s gender affects coping strategies.

Current self-management strategies have been designed largely with women in mind. A paucity of studies have examined this disparity between women and men with rheumatoid arthritis. The authors investigated the subjective support preferences of men with rheumatoid arthritis and reported their findings in a recent Arthritis Care & Research article.

The study

Enrolled in this qualitative study were 22 men with rheumatoid arthritis. They participated in 2-hour focus groups, a topic guide was followed, and a health assessment questionnaire was completed.

The results

Challenges to masculinity

• Men reported a reduction in their strength and abilities related to rheumatoid arthritis.

• “It’s so soul destroying because what it does, it takes away your…yeah, your dignity.” (Quote from a subject in the study.)

• Male subjects noted a loss of independence as well as suffering with rheumatoid arthritis being a challenge to their masculine identity and role.

• Subjects often hid their symptoms in public.

•Some subjects said they felt a power imbalance while interacting with the health care team.

Getting through life with rheumatoid arthritis

• A prevailing thought among subjects was to simply “get on with it (life).”

• Men in the study often used aids, such as electric screwdrivers, to perform tasks.

• Many subjects found information seeking useful in their attempts to retain control by staying up-to-date about their disease.

• Frequently used destructive behaviors included overdoing physical activity, skipping medications to avoid symptoms, and drinking alcohol to excess.

• Some men with rheumatoid arthritis withdrew socially to avoid interactions; others reported looking to family and finding support there.

• The majority of men with rheumatoid arthritis said that friends were not understanding.

Acceptable types of support

• Many men thought group sessions might be useful as a support system.

• Men with rheumatoid arthritis thought talking about their disease with others was a feminine strategy.

• Despite thinking group sessions may be helpful, few men thought they would attend.

• There were mixed opinions as to whether a patient or a medical professional should run a group session as well as whether a group should have just men or be of mixed gender.

Implications for physicians

• Men have perceptions about rheumatoid arthritis different from those of women, and they may have very different coping strategies.

• Men clearly have difficulty determining the best coping strategies when dealing with rheumatoid arthritis.

• Men appear to adhere to classic gender stereotypes when thinking about rheumatoid arthritis, focusing on strength, productivity, and independence.

• Men with rheumatoid arthritis are at risk for isolation and are reluctant to talk about their feelings. As such, clinicians should engage these men at every opportunity.

Disclosures:

Arthritis Research UK provided support for this study.

References:

Flurey CA, Hewlett S, Rodham K, et al. "’You Obviously Just Have to Put on a Brave Face’: A Qualitative Study of the Experiences and Coping Styles of Men With Rheumatoid Arthritis.” Arthritis Care Res (Hoboken). 2017;69:330-337. doi: 10.1002/acr.22951.