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Sex Differences in the Achievement of Remission and Low Disease Activity in Rheumatoid Arthritis


Maynard C1, Mikuls TR2,3, Cannon GW4, England BR2,3, Conaghan PG5, Østergaard M6,7, Baker DG8, Kerr G9, George MD, Barton JL10, Baker JF1,11,12. Arthritis Care Res (Hoboken). 2019 Mar 15. doi: 10.1002/acr.23873. [Epub ahead of print]

Author Information

1 University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA.

2 Medicine Service VA, Nebraska-Western Iowa Health Care System, Omaha, NE, USA.

3 Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA.

4 Salt Lake City VA Medical Center and University of Utah, Salt Lake City, UT.

5 Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Biomedical Research Centre, Leeds, UK.

6 Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark.

7 Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.

8 Janssen Research& Development, LLC, Horsham, PA, USA.

9 Washington DC VA Medical Center, Georgetown and Howard Universities, Washington, DC, USA.

10 VA Portland Health Care System, Portland, OR, USA.

11 Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA.12Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA.



In rheumatoid arthritis (RA), it is unclear if women are less likely to achieve low disease activity (LDA). We evaluated sex differences in remission and LDA, comparing different clinical and imaging measures.


We utilized data from the Veterans Affairs RA (VARA) registry and from two clinical trials. Remission and LDA were defined using composite scores, individual items (tender joints, swollen joints, ESR, CRP, evaluator/patient global assessment), and MRI. In VARA, we assessed 1) the likelihood of point remission at any time during follow-up using logistic regression, and 2) time to sustained remission (2 consecutive visits) using Cox proportional hazard models. In the clinical trials, logistic regression models evaluated the likelihood of low clinical and MRI activity at 52 weeks.


Among 2463 patients in VARA women (10.2%) were less likely to be in DAS28-ESR remission in follow-up [OR: 0.71 (0.55, 0.91) p<0.01] and had a longer time to sustained DAS28-ESR remission. This difference was not observed for DAS28-CRP, CDAI, or RAPID3. Women were more likely to achieve favorable individual components except for an ESR <30 mm/hr [OR: 0.72 (0.57, 0.90) p<0.01]. Among 353 trial participants, (83.7% women), women had reduced rates of DAS28-ESR remission [OR: 0.39 (0.21, 0.72) p=0.003] but similar rates of low MRI synovitis and osteitis.


The comparison of remission rates between men and women varies based on the disease activity measure, with sex-specific differences in ESR resulting in reliably lower rates of remission among women. There were no differences in MRI-measures.