Advances in The Management of Rheumatic Disease - Episode 2

Rheumatic Disease Management: Gender and Quality of Life

September 5, 2019

Sergio Schwartzman, MD: Gender is a critical element depending on the disease that we are considering. If we talk about extremes, gout, for example, is much more common in men than it is in women, whereas lupus is 10 times more common in women than it is in men. We don’t really understand that yet, although I think 1 of the hypotheses, perhaps a little bit simplistic, has been that it is due to hormonal differences across men and women. That hasn’t been well established. Many years ago, there were studies on hormonal manipulation as a manner of addressing therapy for women who have lupus.

The other thing about gender differences is that it is not always what it seems. As an example of that, if we look at axial spondyloarthritis, which is inflammatory disease that predominantly affects the axial skeleton, we have now divided that into 2 categories: radiographic axial spondyloarthritis, or ankylosing spondylitis, and nonradiographic axial spondyloarthritis. That is when we don’t have x-ray changes but either have just MRI [magnetic resonance imaging] changes or patients who are HLA-B27 positive and have features of spondyloarthritis.

We used to think that ankylosing spondyloarthritis was predominantly a disease of men. However, as we’ve now redefined this group of diseases into axial spondyloarthritis, we’re learning that nonradiographic axial spondyloarthritis, which is in this same spectrum, may be slightly more common in women than it is in men.

So, gender differences exist. They’re not yet well explained, and they’re not static. I think this example of axial spondyloarthritis, where nonradiographic axial disease is more common in women than it is in men, is an example where our view of this whole group of diseases is changing. That sometimes has been a challenge because older physicians, of which I guess I’m one now, used to think that axial spondyloarthritis was predominantly a disease of men, and it isn’t. This group of diseases are at least as common in women.

I think quality of life has become an increasing interest in terms of treatment for the management of rheumatic diseases because it was such a challenge in the past. When I started in rheumatology 34 years ago, about 50% of patients who had rheumatoid arthritis were disabled within 5 years of developing the disease. This is an enormous burden on quality of life. That doesn’t happen anymore because our therapy is so much better.

Nonetheless, we do understand that quality of life is a critical element in a patient’s normal life. It’s not something that we had the capacity to modify in the past, but we do now, because the new therapies that we have impact on quality of life. Therefore, we’ve become much more critical in terms of measuring quality of life in patients who have rheumatic diseases and who are being treated. There are outcome measures such as the health assessment questionnaire, the HAQ, or the PROMIS [Patient Reported Outcomes Measurement Information System] questionnaires that are very specific, targeting quality of life measures. I would conclude by saying that quality of life is impacted by rheumatic diseases. We now have the capacity to measure that, and what’s important is we have therapies that very much have influenced quality of life measures in our patients.

Transcript edited for clarity.