Men with rheumatoid arthritis, psoriasis, and inflammatory bowel disorder feel better after taking biologic agents than female patients do. Does under-treatment of women occur because doctors discount their subjective reports of pain?
Women with inflammatory diseases (rheumatoid arthritis, psoriasis, and inflammatory bowel disorder) generally have worse scores for pain and quality of life than do men. But doctors often discount these subjective measures, which can lead to under-treatment of women.
That’s the conclusion of a new study of gender and treatment of immune-mediated chronic inflammatory diseases, which found that women scored higher on subjective, but not objective, measures of disease activity than men.
Research into gender and inflammatory disorders is limited, and somewhat contradictory. For instance, the authors from Denmark and Sweden note that several studies show a slightly higher incidence of IBD among women than men. However, the risk of progression to cancer appears to be higher among men. Although RA is about 3 times more common among women than among men in developed countries, joint erosion appears to set in earlier and more severely among men.
The observational study from the Karolinska Institute in Sweden and Radboud University in the Netherlands, included nearly 4,500 adult patients with RA, IBD, or psoriasis who were treated with biologic agents from 1999 to 2010 after standard therapies failed to control their disease. The researchers found no significant differences between men and women in their choice of biologics for all three diseases.
Among more than 1900 patients with RA and more than 130 IBD patients, both men and women had similar disease severity at the start of biologic therapy, but there was a trend suggesting that female patients experienced more objective symptoms. Yet, there was a treatment difference -- men with IBD or psoriasis received biologics more often than women. Treatment for RA was consistent with the gender ratio, but women fared worse subjectively despite treatment.
Why were more men than women treated with biologics? The authors hypothesize that men have more severe disease activity, may be more likely than women to express treatment preferences for biologics/systemic agents, or may have better access to treatment for some reason. Also, there may be a gender difference in the effectiveness of biologics and treatment alternatives.
Is it possible that women simply have better recall, experience more psychosomatic symptoms, and are more willing to express negative feelings? Probably not, say the authors of a British study of ulcerative colitis, who controlled for this type of potential bias.
Their cross-sectional observational study of ulcerative colitis included more than 100 patients from a district general hospital in the northeast of England who had filled out quality-of-life questionnaires. The researchers found a strong relationship between individual symptoms and health-related quality of life, but little association with age, gender, physiological markers of disease activity, or the extent of anatomic disease.
The best strategy for improving quality of life for these patients, state the British authors, is to find ways to reduce their symptoms.
1. Lesuis N, Befrits R