Rheumatology Unit, Clinic for Gastroenterology und Rheumatology, Department of Internal Medicine, Neurology and Dermatology, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany.
Clin Rev Allergy Immunol. 2019 Jun;56(3):346-361. doi: 10.1007/s12016-017-8631-6.
Inflammatory rheumatic diseases such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) show a striking female predominance ranging from 3:1 in RA up to 9:1 in SLE. The background for those gender bias is not fully understood yet, but seems to be the result of a complex interaction between sex hormones, (epi-)genetics, and possibly even the composition of gut microbiota. Moreover, time of disease onset, the clinical phenotype including co-morbidities as well as the course of the diseases during life differ between genders. The patient's sex therefore plays an emerging role for individual therapy decisions and co-morbidity screening in rheumatologic care. Male lupus patients, for example, tend to show more severe features such as renal involvement, pleurisy, and serositis, when being compared to female patients. Among RA patients, women are more likely to acquire conditions like thyroid dysfunctions, fibromyalgia, and depression than their male counterparts. These examples emphasize the importance of the patient's gender for the clinical routine and the resulting implications for prevention and therapy. The present article is going to review potential causes for the female predominance of rheumatic diseases and will examine the gender's impact on the disease phenotype, symptom severity, co-morbidities, and quality of life. For reasons of scope, the focus will be on RA and SLE as two of the most important rheumatic diseases with a large socioeconomic impact on society due to their incidence as well as mortality.
炎症性风湿病，如类风湿关节炎（RA）和系统性红斑狼疮（SLE），表现出明显的女性优势，RA 中男女比例为 3:1，SLE 中为 9:1。这种性别偏见的背景尚未完全了解，但似乎是性激素、（表观）遗传学，甚至可能是肠道微生物组的组成之间复杂相互作用的结果。此外，疾病的发病时间、包括合并症在内的临床表型以及生命过程中的疾病进程在性别之间存在差异。因此，患者的性别在风湿科护理中的个体化治疗决策和合并症筛查中起着新兴作用。例如，与女性患者相比，男性狼疮患者往往表现出更严重的特征，如肾脏受累、胸膜炎和浆膜炎。在 RA 患者中，女性比男性更容易出现甲状腺功能障碍、纤维肌痛和抑郁症等疾病。这些例子强调了患者性别对临床常规的重要性，以及对预防和治疗的影响。本文将回顾风湿性疾病女性优势的潜在原因，并研究性别对疾病表型、症状严重程度、合并症和生活质量的影响。由于篇幅限制，本文的重点将放在 RA 和 SLE 上，这两种疾病是最重要的两种风湿性疾病之一，由于其发病率和死亡率，对社会造成了巨大的社会经济影响。
