Gender Disparity In Anti-TNF Treatment For Rheumatoid Arthritis, New Study Reveals

Main Category: Arthritis / Rheumatology
Also Included In: Pain / Anesthetics
Article Date: 19 Jun 2007 - 7:00 PDT

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Findings reported at EULAR 2007, the Annual European Congress of Rheumatology (EULAR) in Barcelona, Spain, reveal a treatment disparity between female and male patients with rheumatoid arthritis (RA). Data from a study at the Karolinska Institute, Sweden, show that women receive anti-TNFs (very effective but expensive modern medications against this disease) at a higher perceived level of disease activity and when they are reporting more severe pain than their male counterparts.

Whilst some disease activity measurements were found to be higher for women than men, and self-reported disease activity by the patients themselves echoed this, the physicians' global assessments showed little difference between the level of disease in the men and women of the study group.

Lead researcher Dr Ronald van Vollenhoven comments, "Women are known to have consistently worse long-term outcomes in rheumatoid arthritis than men. To date, it has been unclear if this is due to factors intrinsic to the disease or because of gender-related prescribing. Our study does not show a gender-bias as such, but does indicate that physicians to some extent 'discount' the subjective measures of disease activity, which we found to be higher in women, and let their decisions be driven almost solely by objective markers of the disease. As a result, women are receiving anti-TNFs at a higher level of disease symptoms than men. Because the goal of any treatment for RA must be to relieve the patients suffering, it is not clear that this approach is the right one."

The study analysed baseline variables for the patients on RA who were started on anti-TNF treatment in the STURE Registry (the Stockholm TNF-alpha follow-up registry). When anti-TNFs were first prescribed to the 644 study participants, the level of their RA severity was logged, as measured according to Disease Activity Scale 28 (DAS28) which takes into account the severity of disease across the 28 joints most commonly affected by RA.

Each participant's Erythrocyte Sedimentation Rate (ESR), which measures the level of inflammation, was also noted along with their Swollen Joint Count (SJC) and Tender Joint Count (TJC). Furthermore, both patients and their physicians completed a global assessment of disease activity, pain and physical activity (5 point scale questionnaire).

DAS28 scores at initiation of anti-TNF treatment were found to be significantly higher for women than for men (DAS28 was 5.53 for women, 5.04 for men, p=0.0006) and women had higher Tender Joint Counts (9.62 compared to 8.41 for males, p=0.066). The women in the study also had significantly higher ESR scores, although the authors suggest that this could be explained in part by the female hormone oestrogen, which affects tends to raise the ESR.

With regard to the more subjective self-reporting on the disease, through the patient-completed global health ratings, women also reported significantly worse global health (as measured by VAS and HAQ-disability index). However, the physician-completed global health ratings were equivalent for men and women.

Dr Ronald van Vollenhoven comments, "This study shows the importance of taking into account both objective and subjective measurement scores in treatment decisions. It is our hope that these data will help redress this imbalance and ensure equal prescribing and disease management for all."

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Article adapted by Medical News Today from original press release.
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Abstract number: THU0218

About EULAR

* The European League Against Rheumatism (EULAR) is the organization which represents the patient, health professional and scientific societies of rheumatology of all the European nations.

* The aims of EULAR are to reduce the burden of rheumatic diseases on the individual and society and to improve the treatment, prevention and rehabilitation of musculoskeletal diseases. To this end, EULAR fosters excellence in education and research in the field of rheumatology. It promotes the translation of research advances into daily care and fights for the recognition of the needs of people with musculoskeletal diseases by the governing bodies in Europe.

* Diseases of bones and joints, such as rheumatoid arthritis and osteoarthritis cause disability in 4 - 5 % of the adult population and are predicted to rise as people live longer.

* As new treatments emerge and cellular mechanisms are discovered, the 8th Annual European Congress of Rheumatology in Barcelona (EULAR 2007) brings together more than 10,000 experts - scientists, clinicians, healthcare workers, pharmaceutical companies and patients - to share their knowledge in a global endeavour to challenge the pain and disability caused by musculo-skeletal disorders.

* To find out more information about the activities of EULAR, visit: http://www.eular.org/

Contact: Rory Berrie
European League Against Rheumatism