It’s time to move to a more gender-specific approach to treatment, ACR delegates have heard.
The groundswell of evidence suggesting women and men with psoriatic arthritis (PsA) have different symptoms, pain perception, time-to-diagnosis and response to biologic therapies was a hot topic at ACR Convergence 2024.
Rheumatologist Lihi Eder, Associate Professor of medicine at Women’s College Hospital and University of Toronto in Canada, was just one of the speakers to address the subject.
She discussed how sex-related biological and gender-related sociocultural differences affect PsA outcomes at the American College of Rheumatology’s annual meeting in Washington DC.
“Our approach currently is gender blinded. We assume that what works for males automatically works for females and this may not be true,” she told ACR.
“I think generally we should be start thinking about moving to a more gender specific approach and considering some of the mechanisms that might be driving the differences.”
Professor Eder said “a major gender data gap” prevented researchers from coming up with solutions for addressing these differences between males and females in areas such as in pain, hormones and the immune system.
PsA develops in approximately 30% of people who have psoriasis. It can take several years to diagnose PsA after the onset of symptoms, with women often diagnosed later than men.
“Our group has shown that women experience a longer period of early signs and symptoms than men prior to a PsA diagnosis,” said Professor Eder.
“During this timeframe, people experience musculoskeletal symptoms with minimal objective findings on physical exams, making diagnosis challenging.”
She also suggested that hormonal changes during menopause may lead to the development of PsA but cautioned that these were only hypotheses and more research was needed to understand why women are diagnosed so much later than men.
The same uncertainty surrounds evidence suggesting that older women are diagnosed later than older men and younger women.
Professor Eder said several sex-related factors may contribute to this, including co-existing osteoarthritis, which could cause similar symptoms. Other conditions such as depression, obesity and fibromyalgia, more commonly affecting females, may also result in delay of diagnosis.
“Unconscious biases in the medical community may also play a role, with studies showing that men and women are treated differently when it comes to ordering advanced diagnostic tests, potentially resulting in delays,” she said.
Women also struggled more with PsA symptoms, reporting higher levels of pain, fatigue, physical dysfunction and a lower quality of life, even though men tend to have more severe psoriasis and were more prone to joint damage.
Professor Eder said both sex-related, biological and gender-related sociocultural factors contributed to these differences, noting that even women who do not have arthritis tended to experience pain more intensely than men do.
“Societal expectations, stressors, coping mechanisms and support systems all impact how men and women perceive and cope with PsA,” she says.
Another critical difference, shown in both observational studies and randomised controlled trials, was the way men and women respond to common biologic medications. In general, these drugs were less effective in women and caused more side effects, so women tend to stop taking them sooner.
