PDF herunterladen
Aktuelle Rheumatologie 2011; 36(06): 352-360
DOI: 10.1055/s-0031-1287800
Übersichtsarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Geschlechtsspezifische Aspekte der Rheumatoiden Arthritis

Gender-Specific Characteristics of Rheumatoid Arthritis
D. Huscher
1   Deutsches Rheuma-Forschungszentrum Berlin, Epidemiologie, Berlin
,
C. Sengler
1   Deutsches Rheuma-Forschungszentrum Berlin, Epidemiologie, Berlin
,
K. Thiele
1   Deutsches Rheuma-Forschungszentrum Berlin, Epidemiologie, Berlin
,
S. Bischoff
1   Deutsches Rheuma-Forschungszentrum Berlin, Epidemiologie, Berlin
,
A. Pfäfflin
1   Deutsches Rheuma-Forschungszentrum Berlin, Epidemiologie, Berlin
,
E. Gromnica-Ihle
2   Internistin/Rheumatologin, Berlin
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
14. Oktober 2011 (online)

Auch verfügbar auf
    Lizenzen und Reprints

Zusammenfassung

Hintergrund:

In den letzten Jahren haben geschlechtsspezifische Aspekte bei der Rheumatoiden Arthritis (RA) zunehmende Beachtung gefunden. Während die Dominanz der Frauen und der frühere Erkrankungsbeginn bei ihnen unumstritten sind, werden sowohl der unterschiedliche Phänotyp der RA bei den Geschlechtern sowie auch Veränderungen der RA in Abhängigkeit vom Manifestationsalter heftig diskutiert.

Material und Methoden:

Neben den aktuellen Daten aus der Rheumatologischen Kerndokumentation der Regionalen Kooperativen Rheumazentren wird die wesentliche aktuelle Literatur zu dieser Thematik ausgewertet.

Ergebnisse:

Dabei zeigt sich, dass Frauen mit RA eine deutlich größere Krankheitslast aufweisen, gemessen mit der Schmerzangabe, der Krankheitsaktivität und einer begleitenden Fibromyalgie-Symptomatik einschließlich Fatigue. Der größte Unterschied zu den Männern mit RA besteht im schlechteren Funktionsstatus der Frauen. Diese Differenz scheint sich im Krankheitsverlauf der RA noch weiter zu vergrößern. Zur radiologischen Progression liegen unterschiedliche Daten vor, diese Frage bleibt offen. Unbestritten ist, dass Männer schneller eine Remission der RA erreichen als Frauen.

Schlussfolgerung:

Die Gründe für diese Differenzen werden diskutiert. Hormonelle Unterschiede und unterschiedlicher Körperbau scheinen eine ebenso wichtige Rolle zu spielen wie Unterschiede in der Verhaltensweise zwischen Männern und Frauen. Weitere Studien zu diesen Fragen sind dringend notwendig. Es könnten sich daraus unterschiedliche Therapiestrategien für Männer und Frauen entwickeln.

Abstract

Background:

In the past decade, gender-specific issues of rheumatoid arthritis (RA) have attracted increasing attention. While the predominance of women and their earlier disease onset is widely accepted, different phenotypes between sexes and alterations of RA depending on age at clinical manifestation are intensely discussed.

Material and Methods:

In this article data from the National Database of the German Collabora­tive Arthritis Centres (Kerndokumentation) and the current literature are evaluated.

Results:

Women with RA suffer from more severe disease, based on pain, disease activity and a concomitant fibromyalgia syndrome also comprising fatigue. Compared to men with RA the major difference is a more limited functional capacity in women. This difference seems to in­crease with disease duration. There are inconsistent data regarding radiological progression, so this question remains unsolved. There is no doubt that men reach remission faster than women.

Conclusion:

Reasons for these differences are subjects of discussion. Hormonal disparities and differing body composition seem to play an equal role as does variation in behaviour between genders. There is an obvious need for more studies on these issues – providing the opportunity to develop different treatment regimens for men and women.

Schlüsselwörter

rheumatoide Arthritis - Geschlecht - Schmerz - Krankheitsaktivität - Funktionsstatus

Key words

rheumatoid arthritis - gender - pain - disease activity - functional capacity
 

  • Literatur

  • 1 Kovacs WJ, Olsen NJ. Sexual dimorphism of RA manifestations: genes, hormones and behavior. Nat Rev Rheumatol 2011 May 7 (5): 307-310
    PubMedGoogle Scholar
  • 2 Arnett FC, Edworthy SM, Bloch DA et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 1988; 31: 315-324
    Google Scholar
  • 3 Symmons D, Turner G, Webb R et al. The prevalence of rheumatoid arthritis in the United Kingdom: new estimates for a new century. Rheumatology (Oxford) 2002; 41: 793-800
    CrossrefPubMedGoogle Scholar
  • 4 Crowson CS, Matteson EL, Myasoedova E et al. The lifetime risk of adult-onset rheumatoid arthritis and other inflammatory autoimmune rheumatic diseases. Arthritis Rheum 2011 Mar 63 (3): 633-639
    PubMedGoogle Scholar
  • 5 Myasoedova E, Crowson CS, Kremers HM et al. Is the incidence of rheumatoid arthritis rising?: results from Olmsted County, Minnesota, 1955–2007. Arthritis Rheum 2010; 62: 1576-1582
    CrossrefPubMedGoogle Scholar
  • 6 Westhoff G, Edelmann E, Zink A. Das Zuweiser-Projekt. Symptomd­auer bis zur Erstvorstellung beim internistischen Rheumatologen. Rheuma-Management 2009; 1: 13-15
    PubMedGoogle Scholar
  • 7 van der Linden MP, le CS, Raza K et al. Long-term impact of delay in assessment of patients with early arthritis. Arthritis Rheum 2010; 62: 3537-3546
    CrossrefPubMedGoogle Scholar
  • 8 Sengler C, Huscher D, Ziegler S et al. Vergleich von Patientinnen mit rheumatoider Arthritis mit prä- oder postmenopausalem Erkrankungsbeginn mit männlichen RA-Patienten gleichen Alters und gleicher Krankheitsdauer bezüglich Krankheitslast, Komorbidität und medikamentöser Behandlung. 37. Kongress der Deutschen Gesellschaft für Rheumatologie, Köln, 23–26. September 2009. Z Rheumatol 2009; 68 (Suppl. 01) 36-37
    PubMedGoogle Scholar
  • 9 Ahlmen M, Svensson B, Albertsson K et al. Influence of gender on assessments of disease activity and function in early rheumatoid arthritis in relation to radiographic joint damage. Ann Rheum Dis 2010; 69: 230-233
    CrossrefPubMedGoogle Scholar
  • 10 Katz PP, Criswell LA. Differences in symptom reports between men and women with rheumatoid arthritis. Arthritis Care Res 1996; 9: 441-448
    CrossrefPubMedGoogle Scholar
  • 11 Leeb BF, Haindl PM, Maktari A et al. Disease activity score-28 values differ considerably depending on patient’s pain perception and sex. J Rheumatol 2007; 34: 2382-2387
    PubMedGoogle Scholar
  • 12 Sokka T, Toloza S, Cutolo M et al. Women, men, and rheumatoid arthritis: analyses of disease activity, disease characteristics, and treatments in the QUEST-RA study. Arthritis Res Ther 2009; 11: R7
    PubMedGoogle Scholar
  • 13 Thyberg I, Dahlstrom O, Thyberg M. Factors related to fatigue in women and men with early rheumatoid arthritis: the Swedish TIRA study. J Rehabil Med 2009; 41: 904-912
    CrossrefPubMedGoogle Scholar
  • 14 Belza BL, Henke CJ, Yelin EH et al. Correlates of fatigue in older adults with rheumatoid arthritis. Nurs Res 1993; 42: 93-99
    PubMedGoogle Scholar
  • 15 Huyser BA, Parker JC, Thoreson R et al. Predictors of subjective fatigue among individuals with rheumatoid arthritis. Arthritis Rheum 1998; 41: 2230-2237
    CrossrefPubMedGoogle Scholar
  • 16 Wolfe F. Fatigue assessments in rheumatoid arthritis: comparative performance of visual analog scales and longer fatigue questionnaires in 7760 patients. J Rheumatol 2004; 31: 1896-1902
    PubMedGoogle Scholar
  • 17 Pollard LC, Choy EH, Gonzalez J et al. Fatigue in rheumatoid arthritis reflects pain, not disease activity. Rheumatology (Oxford) 2006; 45: 885-889
    CrossrefPubMedGoogle Scholar
  • 18 Fries JF, Spitz P, Kraines RG et al. Measurement of patient outcome in arthritis. Arthritis Rheum 1980; 23: 137-145
    CrossrefPubMedGoogle Scholar
  • 19 Iikuni N, Sato E, Hoshi M et al. The influence of sex on patients with rheumatoid arthritis in a large observational cohort. J Rheumatol 2009; 36: 508-511
    CrossrefPubMedGoogle Scholar
  • 20 Kuiper S, van Gestel AM, Swinkels HL et al. Influence of sex, age, and menopausal state on the course of early rheumatoid arthritis. J Rheumatol 2001; 28: 1809-1816
    PubMedGoogle Scholar
  • 21 Tengstrand B, Ahlmen M, Hafstrom I. The influence of sex on rheumatoid arthritis: a prospective study of onset and outcome after 2 years. J Rheumatol 2004; 31: 214-222
    PubMedGoogle Scholar
  • 22 Voulgari PV, Papadopoulos IA, Alamanos Y et al. Early rheumatoid arthritis: does gender influence disease expression?. Clin Exp Rheumatol 2004; 22: 165-170
    PubMedGoogle Scholar
  • 23 Jawaheer D, Maranian P, Park G et al. Disease progression and treatment responses in a prospective DMARD-naive seropositive early rheumatoid arthritis cohort: does gender matter?. J Rheumatol 2010; 37: 2475-2485
    CrossrefPubMedGoogle Scholar
  • 24 Raspe H, Hagedorn U, Kohlmann T et al. Der Funktionsfragebogen Hannover (FFbH): Ein Instrument zur Funktionsdiagnostik bei polyartikulären Gelenkerkrankungen. In: Siegrist J. Hrsg Wohnortnahe Betreuung Rheumakranker. Ergebnisse sozialwissenschaftlicher Evaluation eines Modellversuchs. Stuttgart: Schattauer; 1990: 164-182
    Google Scholar
  • 25 Steinbrocker O, Traeger CH, Battermann RC. Therapeutic criteria in rheumatoid arthritis. JAMA 1949; 140: 659-662
    CrossrefPubMedGoogle Scholar
  • 26 Jawaheer D, Lum RF, Gregersen PK et al. Influence of male sex on disease phenotype in familial rheumatoid arthritis. Arthritis Rheum 2006; 54: 3087-3094
    CrossrefPubMedGoogle Scholar
  • 27 Weyand CM, Schmidt D, Wagner U et al. The influence of sex on the phenotype of rheumatoid arthritis. Arthritis Rheum 1998; 41: 817-822
    CrossrefPubMedGoogle Scholar
  • 28 Wolfe F, Sharp JT. Radiographic outcome of recent-onset rheumatoid arthritis: a 19-year study of radiographic progression. Arthritis Rheum 1998; 41: 1571-1582
    CrossrefPubMedGoogle Scholar
  • 29 Gossec L, Baro-Riba J, Bozonnat MC et al. Influence of sex on disease severity in patients with rheumatoid arthritis. J Rheumatol 2005; 32: 1448-1451
    PubMedGoogle Scholar
  • 30 Syversen SW, Gaarder PI, Goll GL et al. High anti-cyclic citrullinated peptide levels and an algorithm of four variables predict radiographic progression in patients with rheumatoid arthritis: results from a 10-year longitudinal study. Ann Rheum Dis 2008; 67: 212-217
    CrossrefPubMedGoogle Scholar
  • 31 van der Heijde D. How to read radiographs according to the Sharp/van der Heijde method. J Rheumatol 2000; 27: 261-263
    PubMedGoogle Scholar
  • 32 Forslind K, Hafstrom I, Ahlmen M et al. Sex: a major predictor of remission in early rheumatoid arthritis?. Ann Rheum Dis 2007; 66: 46-52
    PubMedGoogle Scholar
  • 33 Saevarsdottir S, Wallin H, Seddighzadeh M et al. Predictors of response to methotrexate in early DMARD naive rheumatoid arthritis: results from the initial open-label phase of the SWEFOT trial. Ann Rheum Dis 2011; 70: 469-475
    CrossrefPubMedGoogle Scholar
  • 34 Hoekstra M, van Ede AE, Haagsma CJ et al. Factors associated with toxicity, final dose, and efficacy of methotrexate in patients with rheumatoid arthritis. Ann Rheum Dis 2003; 62: 423-426
    CrossrefPubMedGoogle Scholar
  • 35 Wessels JA, van der Kooij SM, le CS et al. A clinical pharmacogenetic model to predict the efficacy of methotrexate monotherapy in recent-onset rheumatoid arthritis. Arthritis Rheum 2007; 56: 1765-1775
    CrossrefPubMedGoogle Scholar
  • 36 Wallenius M, Skomsvoll JF, Koldingsnes W et al. Comparison of work disability and health-related quality of life between males and females with rheumatoid arthritis below the age of 45 years. Scand J Rheumatol 2009; 38: 178-183
    CrossrefPubMedGoogle Scholar
  • 37 Ranzolin A, Brenol JC, Bredemeier M et al. Association of concomitant fibromyalgia with worse disease activity score in 28 joints, health assessment questionnaire, and short form 36 scores in patients with rheumatoid arthritis. Arthritis Rheum 2009; 61: 794-800
    CrossrefPubMedGoogle Scholar
  • 38 Wolfe F, Michaud K. Severe rheumatoid arthritis (RA), worse outcomes, comorbid illness, and sociodemographic disadvantage characterize ra patients with fibromyalgia. J Rheumatol 2004; 31: 695-700
    PubMedGoogle Scholar
  • 39 Naranjo A, Ojeda S, Francisco F et al. Fibromyalgia in patients with rheumatoid arthritis is associated with higher scores of disability. Ann Rheum Dis 2002; 61: 660-661
    CrossrefPubMedGoogle Scholar
  • 40 da Silva JA, Hall GM. The effects of gender and sex hormones on outcome in rheumatoid arthritis. Baillieres Clin Rheumatol 1992; 6: 196-219
    PubMedGoogle Scholar
  • 41 Gromnica-Ihle E, Ostensen M. Schwangerschaft bei rheumatoider Arthritis oder Spondylarthropathien. Z Rheumatol 2006; 65: 209-216
    CrossrefPubMedGoogle Scholar
  • 42 de Man YA, Dolhain RJ, van de Geijn FE et al. Disease activity of rheumatoid arthritis during pregnancy: results from a nationwide prospective study. Arthritis Rheum 2008; 59: 1241-1248
    CrossrefPubMedGoogle Scholar
  • 43 Walitt B, Pettinger M, Weinstein A et al. Effects of postmenopausal hormone therapy on rheumatoid arthritis: the women’s health initiative randomized controlled trials. Arthritis Rheum 2008; 59: 302-310
    CrossrefPubMedGoogle Scholar
  • 44 Costenbader KH, Manson JE. Do female hormones affect the onset or severity of rheumatoid arthritis?. Arthritis Rheum 2008; 59: 299-301
    CrossrefPubMedGoogle Scholar
  • 45 Booji A, Biewenga-Booji CM, Huber-Bruning O et al. Androgens as adjuvant treatment in postmenopausal female patients with rheumatoid arthritis. Ann Rheum Dis 1996; 55: 811-815
    CrossrefPubMedGoogle Scholar
  • 46 Stoll T, Huber E, Seifert B et al. Maximal isometric muscle strength: normative values and gender-specific relation to age. Clin Rheumatol 2000; 19: 105-113
    CrossrefPubMedGoogle Scholar
  • 47 Beenakker KG, Ling CH, Meskers CG et al. Patterns of muscle strength loss with age in the general population and patients with a chronic inflammatory state. Ageing Res Rev 2010; 9: 431-436
    CrossrefPubMedGoogle Scholar
  • 48 Hanna FS, Teichtahl AJ, Wluka AE et al. Women have increased rates of cartilage loss and progression of cartilage defects at the knee than men: a gender study of adults without clinical knee osteoarthritis. Menopause 2009; 16: 666-670
    CrossrefPubMedGoogle Scholar
  • 49 van Vollenhoven RF. Sex differences in rheumatoid arthritis: more than meets the eye. BMC Med 2009; 7: 12
    CrossrefPubMedGoogle Scholar