The Effects of Sex on Patient Reported Outcomes in Inflammatory Arthritis and Connective Tissue Diseases


Background: It was thought that women report higher pain than men. We studied if there was a sex difference for several patient reported outcomes (PROs) in rheumatic diseases. Materials and Methods: Health Assessment Questionnaire disability index (HAQ-DI) as well as 100 mm Visual Analogue Scale (VAS) for pain, fatigue, sleep disturbance, and patient global assessment were compared cross-sectionally between the sexes for ankylosingspondylitis (AS), psoriatic arthritis (PsA), rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and systemic sclerosis (SSc). Data were collected using standardized forms administered during routine care. Results: The sample included 136 patients (97 males) with AS, 200 (83 males) with PsA, 232 (40 males) with RA, 199 (12 males) with SLE, and 113 (17 males) with SSc. There were no significant differences in AS. There were sex differences in PsA for HAQ (0.85 females, 0.57 males; p < 0.003), pain (45.2 females, 36.8 males; p < 0.03), sleep (42.1 females, 31.6 males; p < 0.025), and not significantly for fatigue and global scores (fatigue: 44.4 females, 36.0 males; p < 0.07. global: 40.1 females, 33.1 males; p < 0.06). There were similar non-significant differences observed in RA and SLE; whereas, in SSc, men had a higher global assessment (52.9 males, 38.1 females; p < 0.03). Conclusions: A significant sex difference was observed in PsA with females reporting worse symptoms. In SSc, global assessments were worse in males possibly due to proportionately more diffuse cutaneous SSc. Sex differences for PROs are not consistent between rheumatic inflammatory diseases in prevalent patients.

Share and Cite:

J. Lee and J. Pope, "The Effects of Sex on Patient Reported Outcomes in Inflammatory Arthritis and Connective Tissue Diseases," Open Journal of Rheumatology and Autoimmune Diseases, Vol. 3 No. 2, 2013, pp. 59-64. doi: 10.4236/ojra.2013.32010.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] M. Ahlmen, B. Svensson, K. Albertsson, K. Forslind and I. Hafstr?m, “Influence of Gender on Assessments of Disease Activity and Function in Early Rheumatoid Arthritis in Relation to Radiographic Joint Damage,” Annals of the Rheumatic Diseases, Vol. 69, No. 1, 2010, pp. 230-233.
[2] C. Barnabe, L. Bessette, C. Flanagan, S. Leclercq, A. Steiman, F. Kalache, et al., “Sex Differences in Pain Scores and Localization in Inflammatory Arthritis: A Systematic Review and Metaanalysis,” The Journal of Rheumatology, Vol. 39, No. 6, 2012, pp. 1221-1230. doi:10.3899/jrheum.111393
[3] K. Kaarela, “Prognostic Factors and Diagnostic Criteria in Early Rheumatoid Arthritis,” Scandinavian Journal of Rheumatology, Vol. 14, No. s57, 1985, pp. 1-54. doi:10.3109/03009748509104317
[4] W. Lee, J. D. Reveille, J. C. J. Davis, T. J. Learch, M. M. Ward and M. H. Weisman, “Are There Gender Differences in Severity of Ankylosing Spondylitis? Results from the PSOAS Cohort,” Annals of Rheumatic Diseases, Vol. 66, No. 5, 2007, pp. 633-638. doi:10.1136/ard.2006.060293
[5] G. Makisara and P. Makisara, “Prognosis of Functional Capacity and Work Capacity in Rheumatoid Arthritis,” Clinical Rheumatology, Vol. 1, No. 2, 1982, pp. 117-125. doi:10.1007/BF02275601
[6] T. Sokka, S. Toloza, M. Cutolo, H. Kautiainen, H. Makinen, F. Gogus, et al., “Women, Men, and Rheumatoid Arthritis: Analyses of Disease Activity, Disease Characteristics, and Treatments in the QUEST-RA Study,” Arthritis Research & Therapy, Vol. 11, No. 1, 2009, p. R7.
[7] E. Myasoedova, C. S. Crowson, H. M. Kremers, T. M. Therneau and S. E. Gabriel, “Is the Incidence of Rheumatoid Arthritis Rising? Results from Olmsted County, Minnesota, 1955-2007,” Arthritis & Rheumatism, Vol. 62, No. 6, 2010, pp. 1576-1582. doi:10.1002/art.27425
[8] D. Khanna, J. E. Pope, P. P. Khanna, M. Maloney, N. Samedi, D. Norrie, et al., “The Minimally Important Difference for the Fatigue Visual Analog Scale in Patients with Rheumatoid Arthritis Followed in an Academic Clinical Practice,” The Journal of Rheumatology, Vol. 35, No. 12, 2008, pp. 2339-2343. doi:10.3899/jrheum.080375
[9] J. Fries, P. Spitz, R. Kraines and H. Holman, “Measurement of Patient Outcome in Arthritis,” Arthritis & Rheumatism, Vol. 23, No. 2, 1980, pp. 137-145. doi:10.1002/art.1780230202
[10] L. Wheaton and J. Pope, “The Minimally Important Difference for Patient-Reported Outcomes in Spondyloarthropathies Including Pain, Fatigue, Sleep, and Health Assessment Questionnaire,” The Journal of Rheumatology, Vol. 37, No. 4, 2010, pp. 816-822. doi:10.3899/jrheum.090086
[11] T. Kwok and J. E. Pope, “Minimally Important Difference for Patient-Reported Outcomes in Psoriatic Arthritis: Health Assessment Questionnaire and Pain, Fatigue, and Global Visual Analog Scales,” The Journal of Rheumatology, Vol. 37, No. 5, 2010, pp. 1024-1028. doi:10.3899/jrheum.090832
[12] J. Pope, D. Khanna, D. Norrie and J. M. Ouimet, “The Minimally Important Difference for the Health Assessment Questionnaire in Rheumatoid Arthritis Clinical Practice Is Smaller than in Randomized Controlled Trials,” The Journal of Rheumatology, Vol. 36, No. 2, 2009, pp. 254-259. doi:10.3899/jrheum.080479
[13] S. Sekhon, J. Pope, Canadian Scleroderma Research Group and M. Baron, “The Minimally Important Difference in Clinical Practice for Patient-Centered Outcomes Including Health Assessment Questionnaire, Fatigue, Pain, Sleep, Global Visual Analog Scale, and SF-36 in Scleroderma,” The Journal of Rheumatology, Vol. 37, No. 3, 2010, pp. 591-598. doi:10.3899/jrheum.090375
[14] K. J. Colangelo, J. Pope and C. Peschken, “The Minimally Important Difference for Patient Reported Outcomes in Systemic Lupus Erythematosus Including the HAQ-DI, Pain, Fatigue, and SF-36,” The Journal of Rheumatology, Vol. 36, No. 10, 2009, pp. 2231-2237. doi:10.3899/jrheum.090193
[15] F. C. Arnett, S. M. Edworthy, D. A. Bloch, D. J. Mc-Shane, J. F. Fries, N. S. Cooper, et al., “The American Rheumatism Association 1987 Revised Criteria for the Classification of Rheumatoid Arthritis,” Arthritis & Rheumatism, Vol. 31, No. 3, 1988, pp. 315-324. doi:10.1002/art.1780310302
[16] M. C. Hochberg, “Updating the American College of Rheumatology Revised Criteria for the Classification of Systemic Lupus Erythematosus,” Arthritis & Rheumatism, Vol. 40, No. 9, 1997, p. 1725. doi:10.1002/art.1780400928
[17] J. M. Moll and V. Wright, “Psoriatic Arthritis,” Seminars in Arthritis and Rheumatism, Vol. 3, No. 1, 1973, pp. 55-78. doi:10.1016/0049-0172(73)90035-8
[18] T. Alfonse, “Preliminary Criteria for the Classification of Systemic Sclerosis (Scleroderma),” Arthritis & Rheumatism, Vol. 23, No. 5, 1980, pp. 581-590. doi:10.1002/art.1780230510
[19] E. C. LeRoy, C. M. Black, R. Fleischmajer, et al., “Scleroderma (Systemic Sclerosis): Classification, Subsets and Pathogenesis,” The Journal of Rheumatology, Vol. 15, No. 2, 1988, pp. 202-205.
[20] S. Van der Linden, H. A. Valkenburg and A. Cats, “Evaluation of Diagnostic Criteria for Ankylosing Spondylitis: A Proposal for Modification of the New York Criteria,” Arthritis & Rheumatism, Vol. 27, No. 4, 1984, pp. 361-368. doi:10.1002/art.1780270401
[21] G. R. Norman, J. A. Sloane and K. W. Wyrwich, “Interpretation of Changes in Health-Related Quality of Life: The Remarkable Universality of Half a Standard Deviation,” Medical Care, Vol. 41, No. 5, 2003, pp. 582-592. doi:10.1097/01.MLR.0000062554.74615.4C

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.