9 Ways PsA Affects Women and Men Differently
Ten years ago, if you had psoriatic arthritis (PsA) it didn’t matter whether you were male or female—the treatment approach for your condition was the same. However, new research is shedding light on how this disease can present differently in women and men. While many questions still need to be answered, it seems the gender divide is real when it comes to how PsA symptoms, genetic connections, level of support, and more all play out. Understanding these differences may be the first step to better managing your PsA. We’ll tell you all we know here.
Women Are More Likely to Have a Strong Genetic Link to PsA
According to a study published in The Lancet, PsA likely develops in complex ways, involving a mix of genetics, environmental influences, and inflammation triggered by a rogue immune response. For women, genetics may even be a leading factor. One scientific review of PsA revealed a family history of psoriasis, which can be a precursor to PsA, in 53% of women studied, while only 44% of men had the same genetic connection. Women with PsA were also almost twice as likely than men to have a first-degree family member—that means a parent or sibling—with PsA.
Men Tend to Have More PsA Back Pain
Men with PsA seem to be most affected in their axial skeleton, which includes the skull, rib cage, and spinal column, according to Dafna D. Gladman, M.D, deputy director at the Centre for Prognosis Studies in the Rheumatic Diseases, in Toronto, Canada. “For men with psoriatic arthritis, axial involvement may present with pain in the axial skeleton, or it may be based on changes seen in either X-rays or magnetic resonance imaging [MRI].” In a review, men were almost two times more likely for their psoriatic arthritis to impact their axial skeleton compared to women.
Women With PsA Often Experience Severe Pain and Depression
A 2020 study in the Journal of Modern Rheumatology tracked the pain scores of men and women with PsA—and found a “significant” difference between the two when measuring pain for disease activity, physical disability, functional limitation, depression, and anxiety, all of which scored higher among female test subjects—although researchers don’t yet understand why. Quality of life scores were higher in male patients. Tamy Buckel, M.D., a clinical dermatologist in Chestertown, M.D., says, “In my clinical practice, women may present differently than men with psoriasis and psoriatic arthritis,” she says. “Women are more likely to have severe pain.”
Men Tend to Show PsA X-Ray Damage Earlier
According to the same study, men with PsA are more likely to show severe damage on X-rays and MRIs throughout their bodies. Researchers mused, “The outcome of disease in men versus women has only recently been addressed [with] little information available right now to answer [why].” The radiographic damage in men, Gladman further explains, “is generally irreversible. However, we’ve seen damage reverse [at times] following treatment with biologic agents." These meds are created with living organisms to reduce inflammation. She adds, “This joint damage can occur in men or women. Men [tend to] get more severe damage than women.”
Women Feel PsA in Their Knees, Elbows, Fingers, and Toes
A different 2020 study also reported that women are three times more likely than men to have peripheral joint involvement—meaning they have more joint pain from PsA. While men may experience more neck and spine discomfort with this inflammatory condition, women are more likely to have what is known as peripheral polyarticular disease. They more often feel pain in five or more joints in their fingers, toes, wrists, elbows, shoulders, ankles, knees, and hips at the same time, or sometimes pain in these locations that moves from joint to joint.
Men With PsA Tend to Suffer Less Disability
The authors of this same study observed, “At any given level of radiographic damage, women report worse functional outcomes.” So, men may have more visual evidence of damage, but women have higher rates of actual disability, meaning their X-rays don’t always jibe with their pain levels. Science is still unpacking possible explanations as to why. Still, Dr. Gladman says there’s hope: “When people are treated early and well for their inflammatory disease, they generally do well … If your psoriatic disease is under control, there is no reason to think you will become disabled.”
Women With PsA Are More Likely to Discontinue Treatment
Treatment for PsA focuses on controlling inflammation. As mentioned, biologic agents are a frequent, first-line approach. While they’ve been shown to be highly effective in curbing PsA symptoms, the possible side effects—including lowered immune function and more opportunistic or flu-like infections—can lead to lots of trial and error with different types. One recent study showed how fewer than one in five people continued on the treatment after 24 months. What’s more, “women are more likely to discontinue or change treatments due to lack of effectiveness and side effects” for “unclear and complex” reasons, according to Dr. Buckel.
Men Are Less Likely to Seek PsA Support
According to Johns Hopkins Medicine, women are more likely to discuss their PsA experience with others, and they rely on close relationships for support. On the other hand, men with PsA are more likely to describe seeking control and not communicating their symptoms, such as fatigue. In a recent review of research in the journal Arthritis Care and Research, men with arthritis preferred support that expanded their knowledge, where women were interested in every type of support option that was available.
Women With PsA Often Report Their Needs Are Not Met at Work
According to the Institute for Work & Health, a study of nearly 500 working baby boomers with inflammatory arthritis, osteoarthritis, or both reported a larger proportion of women said their needs went unmet, whereas a larger proportion of men said that workplace support systems actually exceeded their needs. The researchers believe the disparity may be explained by the larger number of women who work in sales and retail jobs or part-time positions where benefits such as child care, insurance coverage, and time off are less common.
PsA Knowledge Empowers Both Men and Women
Understanding gender differences in PsA can help you better manage your condition, says Dr. Gladman. “It’s important for men and women to understand their own disease. You address things better if you know what is going on. We spend a lot of time explaining the concept of inflammation, that inflammation leads to pain, that it may cause scars which lead to the joint damage. If we don’t treat the inflammation early and well, damage [can] set in, leading to loss of function and disability.” So, male or female, share this story with your doctor—and ask if your treatments are right for you.
More Severe Pain: Modern Rheumatology. (July 7, 2020.) “The effect of gender on disease activity and clinical characteristics in patients with axial psoriatic arthritis.” tandfonline.com/doi/abs/10.1080/14397595.2020.1812870
More Back Pain: International Journal of Clinical Rheumatology (2012.) “Gender-related differences in patients with psoriatic arthritis.” openaccessjournals.com/articles/genderrelated-differences-in-patients-with-psoriatic-arthritis.pdf
Peripheral Polyarticular Disease: Clinical and Developmental Immunology. (April 16, 2013.) “Women and polyarticular: Clinical differences between men and women with psoriatic arthritis: Relevance of the analysis of genes and polymorphisms in the major histocompatibility complex region and the age at onset of psoriasis.” ncbi.nlm.nih.gov/pmc/articles/PMC3652135/
Annuals of Rheumatic Disease. (2020.) “Gender differences in psoriatic arthritis disease characteristics: evidence for worse disease in women.” ard.bmj.com/content/annrheumdis/79/Suppl_1/1692.1.full.pdf
Discontinuing Treatment: Current Medical Research and Opinion. (2020.) “Real-world 2-year treatment patterns among patients with psoriatic arthritis treated with injectable biologic therapies.” tandfonline.com/doi/full/10.1080/03007995.2020.1754186
Disability: Modern Rheumatology. (August 21, 2020.) “The effect of gender on disease activity and clinical characteristics in patients with axial psoriatic arthritis.” pubmed.ncbi.nlm.nih.gov/32820672/
Work Needs: Institute for Work and Health. (Summer, 2018.) “Sex/gender analysis: Men and women with arthritis have same needs at work, but not the same supports.” iwh.on.ca/newsletters/at-work/93/sexgender-analysis-men-and-women-with-arthritis-have-same-needs-at-work-but-not-same-supports
Family History: The Lancet. (June 2, 2018.) “The pathogenesis of psoriatic arthritis.” thelancet.com/journals/lancet/article/PIIS0140-6736(18)30830-4/fulltext
Family History: Annuals of Rheumatic Disease. (2012.) “Gender difference in disease expression, radiographic damage and disability among patients with psoriatic arthritis.” pubmed.ncbi.nlm.nih.gov/22589379/
Women and Support: Johns Hopkins Medicine. (2020.) “Gender differences in psoriatic arthritis.” clinicalconnection.hopkinsmedicine.org/news/gender-differences-in-psoriatic-arthritis
Women and Support: Arthritis Care and Research. (2018). “Coping strategies, psychological impact, and support preferences of men with rheumatoid arthritis: A multicenter survey.” pubmed.ncbi.nlm.nih.gov/28941220/