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The impact of gender on time to rheumatoid arthritis classification: a retrospective analysis of a population-based cohort


The objective is to compare the time to fulfillment of 1987 and 2010 ACR/EULAR classification criteria between female and male patients with rheumatoid arthritis (RA) and to assess the potential impact of gender on the time to DMARD therapy. Time from first provider-documented joint swelling to fulfillment of 1987 and 2010 ACR/EULAR criteria was measured in a population-based cohort of adults with incident RA, who were stratified by male or female gender. Disease characteristics, time to start of DMARD therapy, and choice of initial DMARD were compared between groups. The study included 214 patients with RA (148 females and 66 males). Median times from first joint swelling to fulfillment of 1987 (6.5 vs 2.5 days, p = 0.48) and 2010 (1 vs 0 days, p = 0.34) classification criteria were not different between female and male patients overall. There was no difference in time to first DMARD therapy in female vs male patients (15.5 vs 16 days, p = 0.90), and methotrexate was used most frequently as first DMARD in both genders (61% female vs 64% male, p = 0.76). Among the 49 female and 20 male RF/ACPA-negative patients, females experienced a higher median time from first joint swelling to fulfillment of the 1987 (65 vs 11 days, p = 0.063) and 2010 (65 vs 0 days, p = 0.035) classification criteria. Overall, there was no significant delay in meeting 1987 and 2010 ACR/EULAR classification criteria between female and male RA patients, though time to meeting both 1987 and 2010 criteria was slightly longer in males compared with females. Among seronegative patients, females experienced a significant delay to meeting 2010 criteria from first clinically detected synovitis.

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This work was supported by a grant from the National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (Award Number R01AR46849), and was made possible using the resources of the Rochester Epidemiology Project, which is supported by the National Institute on Aging of the NIH under Award Number R01AG034676. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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Correspondence to Cynthia S. Crowson.

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Coffey, C.M., Davis, J.M. & Crowson, C.S. The impact of gender on time to rheumatoid arthritis classification: a retrospective analysis of a population-based cohort. Rheumatol Int 39, 2025–2030 (2019).

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  • Rheumatoid arthritis
  • Gender bias
  • Sex factors
  • Early diagnosis
  • Early arthritis