Background/Purpose: Osteoporosis, diabetes, hypertension and cardiovascular diseases are the most threatening glucocorticoid (GC)-related comorbidities in rheumatoid arthritis (RA), both from the patients and rheumatologists perspective¹. The aim of the study was to evaluate gender differences in the prevalence of GC-related comorbidities in patients with RA in the National Database of the German Collaborative Arthritis Centres.

Methods: Cross-sectional data of patients with RA with valid information on body mass index (BMI) and comorbidities (n=4,438) were analysed regarding the prevalence of osteoporosis, diabetes, cardiac disease and hypertension in women and men, stratified by age, BMI, disease activity (DAS28), education, smoking and GC use (no/≤5/>5-7.5/>7.5mg  prednisone-equivalent per day). Gender differences were compared to those in the age-matched general population. Uni- and multivariable logistic regression analysis was applied to examine background risks in women and men.

Results: Data of 3,353 women and 1,085 men were available for analysis. Osteoporosis was more frequent in female (17.9% vs. 9.2%) while diabetes (10.3% vs. 15.9%), cardiac disease (9.4% vs. 18.3%) and hypertension (36.4% vs. 42.3%) were more often reported in male patients. Compared to the general population, the gender difference was 2.5 times higher for hypertension, 1.8-fold for diabetes, 1.2-fold for cardiac disease and 0.9-fold for osteoporosis. The differences persisted after stratification for GC use, disease activity, age BMI, smoking and education (Table 1). After controlling for these factors in multivariable analysis, women still had more osteoporosis (OR 2.06 [1.59-2.68]) and less diabetes (OR 0.65 [0.52-0.81]) or cardiac disease (OR 0.48 [0.38-0.61].

Conclusion: After controlling for GC use and dosage, age, lifestyle and socioeconomic factors, gender was independently associated with comorbidities that may be GC-related. We found more cardiac diseases, hypertension and diabetes in men and more osteoporosis in women. Except for osteoporosis, the gender differences for these comorbidities were higher in RA patients than in the general population.

1 Van der Goes MC, Jacobs JW, Boers M, et al. Patient and rheumatologist perspectives on glucocorticoids: an exercise to improve the implementation of the European League Against Rheumatism (EULAR) recommendations on the management of systemic glucocorticoid therapy in rheumatic diseases. Ann Rheum Dis 2010;69:1015-21.

Table 1 Prevalence of comorbidities in female (F) and male (M) RA patients by categories of GC use, disease activity, age, BMI, smoking and educational status