Medical Faculty, Radboud University, Geert Grooteplein 21, 6500 HB, Nijmegen, The Netherlands.
BMC Med. 2012 Aug 1;10:82. doi: 10.1186/1741-7015-10-82.
Rheumatoid arthritis (RA), inflammatory bowel disease (IBD), and psoriasis are immune-mediated inflammatory diseases with similarities in pathophysiology, and all can be treated with similar biological agents. Previous studies have shown that there are gender differences with regard to disease characteristics in RA and IBD, with women generally having worse scores on pain and quality of life measurements. The relationship is less clear for psoriasis. Because treatment differences between men and women could explain the dissimilarities, we investigated gender differences in the disease characteristics before treatment initiation and in the biologic treatment prescribed.
Data on patients with RA or IBD were collected from two registries in which patients treated with biologic medication were enrolled. Basic demographic data and disease activity parameters were collected from a time point just before the initiation of the biologic treatment. For patients with psoriasis, the data were taken from the 2010 annual report of the Swedish Psoriasis Register for systemic treatment, which included also non-biologic treatment. For all three diseases, the prescribed treatment and disease characteristics were compared between men and women.
In total, 4493 adult patients were included in the study (1912 with RA, 131 with IBD, and 2450 with psoriasis). Most of the treated patients with RA were women, whereas most of the patients with IBD or psoriasis were men. There were no significant differences between men and women in the choice of biologics. At treatment start, significant gender differences were seen in the subjective disease measurements for both RA and psoriasis, with women having higher (that is, worse) scores than men. No differences in objective measurements were found for RA, but for psoriasis men had higher (that is, worse) scores for objective disease activity measures. A similar trend to RA was seen in IBD.
Women with RA or psoriasis scored significantly higher on subjective, but not on objective, disease activity measures than men, and the same trend was seen in IBD. This indicates that at the same level of treatment, the disease has a greater effect in women. These findings might suggest that in all three diseases, subjective measures are discounted to some extent in the therapeutic decision-making process, which could indicate undertreatment in female patients.
类风湿关节炎（RA）、炎症性肠病（IBD）和银屑病都是具有相似病理生理学的免疫介导的炎症性疾病，都可以用类似的生物制剂进行治疗。先前的研究表明，RA 和 IBD 的疾病特征存在性别差异，女性在疼痛和生活质量测量方面的评分通常较差。银屑病的情况则不太清楚。由于男女之间的治疗差异可能解释了这些差异，我们研究了开始生物治疗前的疾病特征以及所开生物治疗的性别差异。
从两个登记处收集了 RA 或 IBD 患者的数据，这些登记处登记了接受生物药物治疗的患者。从开始生物治疗前的一个时间点收集了基本的人口统计学数据和疾病活动参数。对于银屑病患者，数据来自 2010 年瑞典系统性治疗银屑病登记处的年度报告，其中还包括非生物治疗。对于所有三种疾病，比较了男女之间的规定治疗和疾病特征。
共纳入 4493 名成年患者（1912 名 RA、131 名 IBD 和 2450 名银屑病）。大多数接受 RA 治疗的患者为女性，而大多数 IBD 或银屑病患者为男性。在生物制剂的选择上，男女之间没有显著差异。在治疗开始时，RA 和银屑病的主观疾病测量均存在显著的性别差异，女性的评分高于（即更差）男性。RA 没有发现客观测量的差异，但对于银屑病，男性的客观疾病活动测量评分更高（即更差）。IBD 也出现了类似的趋势。
与男性相比，RA 或银屑病女性患者在主观而非客观疾病活动测量上的评分显著更高，IBD 也出现了同样的趋势。这表明，在相同的治疗水平下，女性的疾病影响更大。这些发现可能表明，在所有三种疾病中，主观测量在治疗决策过程中在某种程度上被低估了，这可能表明女性患者的治疗不足。
