Background/Purpose: Higher scores for women compared to men have been reported for all 7 rheumatoid arthritis (RA) Core Data Set measures (1, 2). Most of these measures predict premature RA mortality (3), but women with RA (and the general population) live 5-10 years longer than men. These findings suggest that higher scores for women may result in part from an ascertainment bias of more candid responses rather than poorer clinical status in women. We sought to probe this possibility by comparing differences between females and males in scores on a patient self-report MDHAQ/RAPID3 (multidimensional health assessment questionnaire/routine assessment of patient index data) vs physician estimates on a RheuMetric checklist.

Methods: All patients (with all diagnoses) at 3 settings complete a MDHAQ at each visit in the waiting area before seeing the rheumatologist. The 2-page MDHAQ includes physical function (FN) in 10 activities of daily living, three 0-10 visual analogue scales (VAS) for pain (PN), patient global estimate (PATGL), fatigue (FT), RADAI self-report joint count, and demographic data. RAPID3 (0-30) is the sum of 0-10 scores from FN, PN, and PATGL. In addition, the rheumatologist completes a RheuMetric checklist, which includes 4 0-10 VAS estimates for overall status, inflammation (reversible), damage (irreversible), and distress (e.g. fibromyalgia and depression). Mean differences between scores of women and men on the patient self-report MDHAQ and physician RheuMetric were compared, using t-tests to estimate statistical significance.

Results: Overall 461 patients were analyzed, 173, 147, and 141 from 3 sites. Females and males were similar in age and education level (Table). All 0-10 MDHAQ scores were ≥0.5 units higher in females than males, p<0.05 for pain, RAPID3, and RADAI self-report joint count. RheuMetric physician 0-10 estimates also were higher in females than males, but differences were 0.2 or less for estimates overall global status, inflammation, and damage (p>0.05). Only physician estimate of distress differed by 0.6 units (p=0.02) (Table).

Conclusion: Female RA patients have higher scores than males, with greater differences for patient self-report measures compared to physician measures other than for distress. These data suggest that higher MDHAQ scores in females may be attributable in part to an ascertainment bias of greater candor rather than clinical severity in females. Further studies of mechanisms for gender differences are needed.

References: 1) Sokka T, et al. Arthritis Res Ther. 2009;11(1):R7. 2) Castrejon Fernandez I, et al. Rheumatol Clin. 2010;6(3):134-40. 3)Sokka T, et al. Clin Exp Rheumatol. 2008;26(5 Suppl 51):S35-61.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/higher-scores-of-women-compared-to-men-for-most-clinical-measures-of-rheumatoid-arthritis-ra-status-greater-differences-for-patient-self-report-scores-than-for-rheumatologist-estimates-a-cross-sec/