Rheumatoid arthritis (RA) affects more females than males, and female hormones may play a role in the onset of the disease. While the symptoms are similar for both sexes, females tend to have more severe symptoms.

Rheumatoid arthritis (RA) causes inflammation of the joints, leading to a range of symptoms, such as pain and stiffness. These symptoms can affect many areas of the body.

RA affects every person differently, but it is common for the symptoms to come and go. People with this condition tend to experience flare-ups when their symptoms worsen and remissions when the disease is more manageable.

It is not clear what causes RA, but there are environmental and genetic risk factors, such as having overweight and smoking. Hormonal factors are likely to contribute, too, as around 75% of people with RA are female.

In this article, we look more closely at the symptoms of RA in females and explain how these may vary at different stages of life.

A note about sex and gender

Sex and gender exist on spectrums. This article will use the terms, “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

The prevalence of RA is 2–3 times higher in young females than in males, with the ratio decreasing with age.

Most diagnoses occur in young females aged 25–45 years. However, researchers in a 2021 study suggest that the changing demographics of the Western world mean that 50% of people currently living with RA are 65 or older at diagnosis.

The symptoms of RA can affect many different parts of the body. The most commonly affected areas include those below:

Learn more about risk factors for RA here.

Joints

The main symptoms of RA include pain, aching, and stiffness in the joints. These typically begin in the smaller, peripheral joints in the body, such as those in the fingers and toes. RA is a symmetrical disease that affects both sides of the body.

It is common for many people’s finger, toe, knee, ankle, or elbow joints to feel stiff, particularly at the start of the day. However, if the stiffness lasts longer than 30 minutes, it may be an early symptom of RA.

Later-stage symptoms of RA include swelling and redness around the affected joints. The joints may feel tender to touch, and moving them may be challenging and painful.

Skin

Around one-quarter of people who have RA may develop rheumatoid nodules. These are firm, raised lumps underneath the skin. Nodules often appear on areas of the body where there is pressure on the skin, such as the elbows.

Treat to target approaches and the use of more effective biologic therapies may reduce the incidence of nodule formation.

Eyes and mouth

RA can cause the eyes and mouth to become dry and irritated. This irritation can also affect the gums, which may be more at risk of infection.

Eye and mouth dryness in RA is often due to an overlap with Sjorgen’s disease. Sjorgen’s is another autoimmune rheumatic disease. Around ten times as many women have a Sjorgen’s diagnosis as men.

RA can also lead to light sensitivity and vision changes.

Lungs and heart

People with RA may experience scarring or inflammation in the lungs, leading to breathing difficulties. Inflammation can also affect the heart and blood vessels.

Inflammation around the heart can cause pain in the chest or fever, while inflamed blood vessels can damage the skin or organs.

Whole body

RA can cause other physical symptoms, such as weight loss, limited joint motion, and muscle weakness.

The disease can also have an impact on mental health and well-being. People with RA have a higher risk of fatigue and depression.

There is a link between hormones and the onset of RA in females. The authors of a 2017 review suggested that estrogen, progesterone, and androgens influence the development of RA.

However, hormones are complex, and their role in RA remains unclear. It seems they may increase the risk of RA in some cases and decrease it in others.

The levels of different hormones in the body change throughout a person’s lifetime. Below, we consider how RA can affect various life events and vice versa:

Pregnancy

People who have been pregnant are less likely to develop RA than those who have not.

If a person who has RA becomes pregnant, they may experience fewer disease symptoms during pregnancy. A 2019 systematic review found that 60% of people saw improved disease activity during pregnancy, but 46.7% of people experienced flares cases postpartum.

Postpartum

Women have a higher risk of developing RA in the first year after giving birth. Experts believe this may be due to the rapid change in hormone levels in the body during this time.

Chestfeeding

Chestfeeding for up to 1 year may decrease the risk of developing RA. However, experts remain divided on whether chestfeeding for more than 1 year increases the person’s risk of RA.

Menopause

A correlation exists between menopause and the onset of RA, but researchers are not clear on the exact connections. A 2018 study of over 8,000 women with RA found that menopause had associations with “a worsening progression of functional decline.”

Endometriosis

Endometriosis is when endometrial-like tissue is present in areas of the body other than the uterine cavity. Although female hormones stimulate the growth of this lining, the condition may also relate to the immune system.

Endometriosis can cause a range of symptoms, including pain and fertility problems. People who have endometriosis may be more at risk of developing RA.

Polycystic ovary syndrome (PCOS)

PCOS affects hormone levels in the body and can cause irregular periods and fertility problems. PCOS may increase the risk of developing RA, but this possible causal link is complicated and requires additional research.

Anti-estrogen medication

Anti-estrogen medication can help treat infertility, breast cancer, and osteoporosis after menopause. Depending on the dosage, this medication may increase a person’s risk of developing RA.

Several genetic factors may contribute to a person’s RA risk.

X chromosome inactivation

During embryo development, one copy of the x chromosome is “inactivated.” This stops the duplication of x chromosome genetic products in people with two x chromosomes.

Studies show that during this process, some gene material escapes. These genes have links to the development of several autoimmune diseases, including rheumatoid arthritis.

Cytokines

Studies show that the interleukin-4 (IL-4) cytokine is less active in females with RA than in males with RA. Cytokines are small proteins that cells release. IL-4 helps to lessen inflammatory responses in the body. A reduction in its efficacy may be a risk factor for RA.

Mitochondria

Mitochondria are essential for cellular energy metabolism and energy production.

Sex hormones regulate mitochondrial function and may affect the development of metabolic, neurodegenerative, and cardiovascular diseases between sexes.

They also help dictate stress responses and immune cell function crucial to the development of RA.

The Centers for Disease Control and Prevention (CDC) recommend that people with RA maintain a moderate weight and quit smoking. Having overweight and smoking with RA can worsen its symptoms and increase the likelihood of developing risk factors, such as high blood pressure.

While there is no identifiable cause of RA, the following conditions may increase a person’s risk of developing RA, or triggering RA flares.

Anyone who is experiencing symptoms of RA should see a doctor.

The doctor will usually complete an initial physical examination before making a referral to a rheumatologist. Rheumatologists specialize in diseases that affect the joints and connective tissue.

The rheumatologist will ask questions about the individual’s medical history and symptoms.

They will usually examine the joints and may also order tests if necessary.

A blood test can measure inflammation and confirm the presence of specific antibodies. Imaging tests, such as an X-ray, can reveal any damage to the joints or inflammation in surrounding tissues.

The primary aim of treatment for RA will usually be to prevent or reduce inflammation.

Controlling the inflammation in RA can lessen the chance of damage to joints or organs. If there are few or no signs of inflammation, doctors will describe RA as being in remission.

A reduction in swelling should allow a greater range of movement, as long as previous disease flare-ups have not damaged the joints.

Doctors will often prescribe medication to ease symptoms and reduce inflammation. They may recommend nonsteroidal anti-inflammatory drugs (NSAIDs) in the form of a tablet to take orally or a cream to apply to the joints.

In some cases, a person may need surgery to repair or replace their joints. Surgery can help decrease pain and improve the range of movement.

RA is a severe disease that can affect the whole body, often causing pain and disability.

There is a link between female hormones and the onset of RA, which tends to occur earlier in females than in males. The hormonal changes that can occur throughout a person’s life, such as those that occur during pregnancy or menopause, can affect the symptoms of the disease.

People can limit the impact of RA on their lives by seeking early treatment and following the advice of a doctor when managing their symptoms.