The Treatment Of Rheumatoid Arthritis

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Rheumatoid Arthritis (RA) is a chronic autoimmune disease of the joints that affects approximately 1.3% of the world population1. RA causes inflammation in the tissue lining the joints, which leads to joint swelling, pain and stiffness2. RA occurs three times more often in women compared to men3. While this sex bias in the prevalence of RA is not yet understood, it has opened a new field of research to investigate sex differences in RA and to gain a better understanding of the etiology and progression of this debilitating disease. Note: Although the terms sex and gender are used to refer to biological vs. psychosocial differences respectively, we have used these terms interchangeably in this paper to refer to sex/gender-related factors to…show more content…
Nonetheless, physical deformities, structural damage, and severe clinical disease activity have been reported equally in both genders. 4 6 However, men with RA have a higher mortality rate and experience a greater number of adverse infections than women, suggesting that they experience more extreme symptoms of the disease 6 7. A possible explanation for this revolves around a discussion regarding the genetic risk factors in men and women for RA. The HLA-DRB1*0401/0404 (Human Leukocyte Antigen) genotype is associated with a 26 fold increase in chances of developing RA, but a 90-fold increased risk in men and more than doubled when age at disease onset was below 308. Given this discussion, there may be a certain threshold related to development of RA8. Since being a female is a huge risk factor for RA, males who do develop RA may have a greater number of other risk factors, increasing the severity of the RA that develops in males. Thus, having the HLA-DRB1*0401/*0404 genotype comes with a substantially high risk for RA development especially in younger males, possibly explaining the higher mortality rate and greater severity of RA in men compared to women8. It is thus far not clear why these sex differences exist. It has been suggested that these sex differences in RA are merely the result of a self-reporting bias in which females possess a different standard for evaluating pain and reporting with greater “candor”.4 Furthermore, sex differences in pain perception are
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