Module 5: Rheumatology
Rheumatologic diseases are a medical example which has been assumed to be gender neutral. Research has failed to address sex and gender differences in these health issues. Major differences in symptoms and disease onset in men and women have an implication on the prevalence and outcome of these diseases and research data are badly needed. That is especially remarkable since most autoimmune diseases are more frequent in women than in men. Ankylosing spondylitis, or Morbus Bechterew, was believed to be significantly more frequent in men in earlier times, but now with advanced diagnostic strategies it becomes clear that the prevalence is similar in women and men. Systemic lupus erythematodes is more frequent in women in the reproductive age than in men (9:1). Its severity is affected by serum estrogen concentration. However, male lupus erythematodes patients are reported to have an increased mortality compared to females. Sjögrens syndrome is also more frequent in women than in men as well as extraglandular manifestation is also more frequent in women than in men, particularly fatigue and arthritis. Rheumatoid arthritis has a 3-4:1 distribution in women and men. It is affected by hormone level changes, e.g. during pregnancy. Male patients benefit more from anti-TNF therapies than females with higher remission rates. For yet unknown reasons, in rheumatic diseases there is a significant diagnostic delay in women in comparison to men.
Author: Dr.med. Ute Seeland