In the October, 2006 issue of Arthritis and Rheumatism, the sex differences in rheumatoid arthritis were explored by studying families who have both male and female members affected by the disease. Each rheumatoid arthritis patient was thoroughly interviewed and examined, and the results were summarized.
It was found that male patients had later onset of rheumatoid arthritis, and showed more signs of destructive disease. Male patients also were more likely to be smokers. Female patients had much poorer function in activities of daily living; and they were more likely to have other autoimmune diseases. Female rheumatoid arthritis patients who had a brother with rheumatoid arthritis were found to have a higher incidence of anti-CCP antibodies (which in some studies have been associated with more severe disease) compared to females without a brother suffering from rheumatoid arthritis.
Interestingly, the findings in this study indicated that the sisters of men with rheumatoid arthritis were approximately twice as likely to be anti-CCP antibody positive, and to have higher concentrations of anti-CCP antibodies compared to the general female rheumatoid arthritis population. In the authors’ conclusion, anti-CCP antibody production is an important predictor of rheumatoid arthritis, and likely more destructive rheumatoid arthritis.
As a practicing rheumatologist, I am forever trying to provide treatment that aggressively treats disease, but I am also aware of the potential toxicity of the drugs I prescribe. Obviously, if I can avoid giving a patient a drug with more potential toxicity, I will do so, but this implies the ability to predict who will be a severe rheumatoid patient versus who will have a more mild course.
Using this study as a guide, I will be sure to take a thorough family history when I interview my rheumatoid arthritis patients. And if I do encounter female rheumatoid arthritis patients who have a brother (or brothers) with rheumatoid arthritis, I might be more inclined to treat such patients with more potent (and perhaps more potentially toxic or expensive) anti-rheumatic medications earlier in the course of the disease, with the hope that I will prevent the destruction seen with more severe rheumatoid arthritis.
There are many dedicated researchers trying to help the practicing rheumatologist determine when to use which types of drugs. There are some patients who will never have more severe rheumatoid arthritis, and therefore will not need more expensive drugs such as Enbrel or Remicade. But there are other rheumatoid arthritics who should be placed on these drugs as soon as possible, to avoid what might be rapid and destructive disease. This study is one more attempt to help the rheumatologist help the patient.