From arthritis to lupus, sex and gender in rheumatology influence diagnosis and treatment

Rheumatological diseases are not the same for everyone. Biological sex and gender significantly influence diagnosis, symptoms, response to drugs and prognosis, making their structural inclusion in clinical practice and in the design of studies, registries and guidelines necessary. This is what emerges from an international review involving the Reference Centre for Gender Medicine of the Istituto Superiore di Sanità, and published in Nature Reviews Rheumatology.

Research shows important differences in prevalence and diagnosis between men and women in the main autoimmune rheumatological diseases, including rheumatoid arthritis, systemic lupus erythematosus and spondyloarthritis. In particular, rheumatoid arthritis and lupus predominantly affect women, while spondyloarthritis is more frequent in men.

According to the authors, in some rheumatological diseases such as rheumatoid arthritis and spondyloarthritis, women are often diagnosed later and their symptoms tend to be underestimated or misinterpreted. One possible cause is the historical under-representation of the gender less affected by these diseases in clinical studies and research.

Differences also emerge in clinical and therapeutic terms: women more frequently report intense pain and fatigue and may show a different response to treatments, particularly to biological and immunomodulating drugs. They also report side effects more frequently and reach remission less often.

The study also points to a significant lack of data on transgender, non-binary and intersex people, who are still underrepresented in clinical research, with implications for the possibility of developing truly inclusive guidelines.