Open Access Highly Accessed Open Badges Research article

Women, men, and rheumatoid arthritis: analyses of disease activity, disease characteristics, and treatments in the QUEST-RA Study

Tuulikki Sokka1*, Sergio Toloza2, Maurizio Cutolo3, Hannu Kautiainen4, Heidi Makinen5, Feride Gogus6, Vlado Skakic7, Humeira Badsha8, Tõnu Peets9, Asta Baranauskaite10, Pál Géher11, Ilona Újfalussy12, Fotini N Skopouli13, Maria Mavrommati14, Rieke Alten15, Christof Pohl15, Jean Sibilia16, Andrea Stancati17, Fausto Salaffi17, Wojciech Romanowski18, Danuta Zarowny-Wierzbinska19, Dan Henrohn20, Barry Bresnihan21, Patricia Minnock22, Lene Surland Knudsen23, Johannes WG Jacobs24, Jaime Calvo-Alen25, Juris Lazovskis26, Geraldo da Rocha Castelar Pinheiro27, Dmitry Karateev28, Daina Andersone29, Sylejman Rexhepi30, Yusuf Yazici31, Theodore Pincus31 and the QUEST-RA Group

Author Affiliations

1 Jyväskylä Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, and Medcare Oy, Hämeentie 1, 44100 Äänekoski, Finland

2 Division of Rheumatology, Hospital San Juan Bautista, Avenida Illia 200, Catamarca, CP:4700, Argentina

3 Research Laboratories and Clinical Academic Unit of Rheumatology, University of Genova Italy, Viale Benedetto XV, 6, 16132 Genova, Italy

4 Medcare Oy, Hämeentie 1, 44100 Äänekoski, Finland

5 Jyväskylä Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland

6 Gazi University, Department of Physical Medicine and Rehabilitation, Division of Rheumatology, 06530 Ankara, Turkey

7 Rheumatology Department, Institute of Rheumatology 'Niska Banja', Srpskih junaka 1, Nis, 18205 Serbia

8 Rheumatology Department, Dubai Bone and Joint Center, Al Razi Building, DHCC, PO Box 118855, Dubai 118855, United Arab Emirates

9 Rheumatology Department, East-Tallinn Central Hospital, Pärnu Road 104, Tallinn 11312, Estonia

10 Rheumatology Department, Kaunas University of Medicine, Eiveniu str.2, Kaunas LT50009, Lithuania

11 1st Department of Rheumatology, Hospitaller Brothers of St John of God Budapest, Árpád f.u.7, H-1027, Budapest, Hungary

12 National Health Center Dept. of Rheumatology, Podmaniczky u. 72, H-1063, Budapest, Hungary

13 Department of Dietetics and Nutrition Science, Harokopio University of Athens and Department of Internal Medicine and Clinical Immunology, Euroclinic of Athens, Athanasiadou 9, 11521, Athens, Greece

14 Department of Internal Medicine and Clinical Immunology, Euroclinic of Athens, Athanasiadou 9, 11521, Athens, Greece

15 Department of Internal Medicine II, Rheumatology, Schlosspark-Klinik Teaching Hospital of the Charité, University Medicine Berlin, Heubnerweg 2, 14059 Berlin, Germany

16 Service de Rhumatologie, CHU de Strasbourg, Hôpital Hautepierre, Avenue Molière, BP 49, 67098 Strasbourg, France

17 Department of Rheumatology, Polytechnic University of Marche, Via dei Colli, 52, 60035, Jesi, Ancona, Italy

18 Poznan Rheumatology Center in Srem, 95 Mickiewicz Street, 63-100 Srem, Poland

19 Wojewodzki Zespol Reumatologiczny im. dr Jadwigi Titz-Kosko, Ul. Grunwaldzka 1/3, 81-759 Sopot, Poland

20 Department of Rheumatology, Uppsala University Hospital, S-75185, Uppsala, Sweden

21 Rheumatology Rehabilitation, Our Lady's Hospice and St. Vincent's University Hospital, Elm Park, Dublin, and University College, Dublin, Ireland

22 Rheumatology Rehabilitation, Our Lady's Hospice, Harold's Cross, Dublin, Ireland

23 Rheumatology Department, Copenhagen University Hospital at Herlev, Herlev Ringvej 75, 2730 Herlev, Denmark

24 Department of Rheumatology and Clinical Immunology F02.127, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands

25 Rheumatology Division, Hospital General Sierrallana, Av. M. Teira s/n 39300 Torrelavega, Cantabria, Spain

26 Rheumatology Section, Riverside Professional Center, 31 Riverside Drive, Sydney, NS, B1S 3N1, Canada

27 Internal Medicine, Pedro Ernesto University Hospital, Boulevard 28 de Setembro 77 sala 333, Rio de Janeiro, 20551-030, Brazil

28 Department of Early Arthritis, Institute of Rheumatology, Kashirskoye shosse, 34a, Moscow, 115522, Russia

29 Medical Faculty of Latvia University, P. Stradina Clinical University Hospital, Pilsonu Street 13, LV 1002, Riga, Latvia

30 Rheumatology Department, University Clinical Center of Kosova, Kodra e diellit, Rr. II, Lamela 11/9, Prishtina, 10 000, Kosova

31 New York University Hospital for Joint Diseases, 301 East 17 Street, New York, NY 10003, USA

For all author emails, please log on.

Arthritis Research & Therapy 2009, 11:R7  doi:10.1186/ar2591

Published: 14 January 2009



Gender as a predictor of outcomes of rheumatoid arthritis (RA) has evoked considerable interest over the decades. Historically, there is no consensus whether RA is worse in females or males. Recent reports suggest that females are less likely than males to achieve remission. Therefore, we aimed to study possible associations of gender and disease activity, disease characteristics, and treatments of RA in a large multinational cross-sectional cohort of patients with RA called Quantitative Standard Monitoring of Patients with RA (QUEST-RA).


The cohort includes clinical and questionnaire data from patients who were seen in usual care, including 6,004 patients at 70 sites in 25 countries as of April 2008. Gender differences were analyzed for American College of Rheumatology Core Data Set measures of disease activity, DAS28 (disease activity score using 28 joint counts), fatigue, the presence of rheumatoid factor, nodules and erosions, and the current use of prednisone, methotrexate, and biologic agents.


Women had poorer scores than men in all Core Data Set measures. The mean values for females and males were swollen joint count-28 (SJC28) of 4.5 versus 3.8, tender joint count-28 of 6.9 versus 5.4, erythrocyte sedimentation rate of 30 versus 26, Health Assessment Questionnaire of 1.1 versus 0.8, visual analog scales for physician global estimate of 3.0 versus 2.5, pain of 4.3 versus 3.6, patient global status of 4.2 versus 3.7, DAS28 of 4.3 versus 3.8, and fatigue of 4.6 versus 3.7 (P < 0.001). However, effect sizes were small-medium and smallest (0.13) for SJC28. Among patients who had no or minimal disease activity (0 to 1) on SJC28, women had statistically significantly higher mean values compared with men in all other disease activity measures (P < 0.001) and met DAS28 remission less often than men. Rheumatoid factor was equally prevalent among genders. Men had nodules more often than women. Women had erosions more often than men, but the statistical significance was marginal. Similar proportions of females and males were taking different therapies.


In this large multinational cohort, RA disease activity measures appear to be worse in women than in men. However, most of the gender differences in RA disease activity may originate from the measures of disease activity rather than from RA disease activity itself.