Weyand C M, Schmidt D, Wagner U, Goronzy J J
Mayo Clinic, Rochester, Minnesota 55905, USA.
Arthritis Rheum. 1998 May;41(5):817-22. doi: 10.1002/1529-0131(199805)41:5<817::AID-ART7>3.0.CO;2-S.
To explore whether there are different disease patterns of rheumatoid arthritis (RA) in women and men.
We studied 55 male case patients and 110 female control patients who developed RA between 1970 and 1985 and who resided and received medical care in Olmsted County, Minnesota, for at least 10 years after the diagnosis of RA. Case and control patients were matched for the date of first diagnosis. The pattern and extent of joint involvement, the frequency of joint surgeries, and the presence and type of extraarticular manifestations were determined by retrospective chart review.
Incidence rates in women were variable and age dependent, whereas the risk in men older than 36 years was constant over their lifetime. Erosive disease was more frequent in men than in women (72% versus 55%, respectively; P < 0.05) and tended to occur earlier (47% versus 31% for erosive disease within the first 4 years of RA). Although male sex was correlated with a higher risk of bony erosions and an accelerated course of RA, structural consequences of joint destruction were more pronounced in women. Joint surgery was performed more frequently in women (50%) than in men (27%) (P = 0.01). In particular, the frequencies of arthroplasties and arthrodeses of hand and foot joints were different (34 procedures in women versus 1 procedure in men; P < 0.001). Sex influenced the risk as well as the pattern of organ involvement in RA. Nodules and rheumatoid lung disease were typical manifestations in men (P = 0.001 and P < 0.001, respectively), whereas women typically developed sicca syndrome (P = 0.05). Despite differences in disease aggressiveness and disease pattern, there was little difference in the medical therapy in the men compared with the women.
RA is a heterogeneous disease with variations in phenotype. Sex-associated factors influence disease severity as well as disease pattern. Because sex-related effects influence treatment goals, treatment responses, and side effects, they should be considered in clinical study design and analysis as well as in the treatment decisions for individual patients with RA.
探讨类风湿关节炎（RA）在男性和女性中是否存在不同的疾病模式。
我们研究了1970年至1985年间患RA且在明尼苏达州奥尔姆斯特德县居住并接受医疗护理至少10年的55例男性病例患者和110例女性对照患者。病例和对照患者按首次诊断日期进行匹配。通过回顾性病历审查确定关节受累的模式和程度、关节手术的频率以及关节外表现的存在和类型。
女性的发病率随年龄变化且与年龄相关，而36岁以上男性的发病风险在其一生中保持恒定。侵蚀性疾病在男性中比在女性中更常见（分别为72%对55%；P<0.05），且往往发生得更早（RA发病后4年内侵蚀性疾病的发生率分别为47%对31%）。虽然男性与更高的骨侵蚀风险和更快的RA病程相关，但关节破坏的结构后果在女性中更为明显。女性进行关节手术的频率（50%）高于男性（27%）（P = 0.01）。特别是，手和足部关节置换术和关节融合术的频率不同（女性34例手术对男性1例手术；P<0.001）。性别影响RA中器官受累的风险和模式。结节和类风湿性肺病是男性的典型表现（分别为P = 0.001和P<0.001），而女性通常出现干燥综合征（P = 0.05）。尽管疾病侵袭性和疾病模式存在差异，但男性与女性相比，药物治疗方面几乎没有差异。
RA是一种具有表型变异的异质性疾病。性别相关因素影响疾病严重程度和疾病模式。由于性别相关效应会影响治疗目标、治疗反应和副作用，因此在临床研究设计和分析以及RA个体患者的治疗决策中都应予以考虑。
