Publish in this journal
Journal Information
Vol. 6. Issue 3.
Pages 134-140 (May - June 2010)
Download PDF
More article options
Vol. 6. Issue 3.
Pages 134-140 (May - June 2010)
Full text access
Influence of gender on treatment response in a cohort of patients with early rheumatoid arthritis in the area 2 of Madrid
Influencia del género en la respuesta al tratamiento en una cohorte de pacientes con artritis reumatoide precoz del área 2 de la Comunidad de Madrid
Isabel Castrejón Fernándeza,??
Corresponding author
, Juan A. Martínez-Lópezb, Ana M. Ortiz Garcíaa, Loreto Carmona Ortellsb, Rosario García-Vicuñab, Isidoro González-Álvaroa
a Servicio de Reumatología, Hospital Universitario “La Princesa”, Madrid, Spain
b Unidad de Investigación, Fundación Española de Reumatología, Madrid, Spain
Article information

To evaluate the differences between the responses to treatment using DAS28 based on erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in male and female patients. We then analyzed the individual behaviour of each component in a cohort of early arthritis patients in zone 2 of Madrid.

Patients and methods

We studied a total of 134 patients (77.6% women) who met the American College of Rheumatology (ACR) criteria for the diagnosis of rheumatoid arthritis (RA) belonging to an early arthritis register of the Hospital de La Princesa. We performed 4 visits following a standardized protocol which included necessary variables to calculate the DAS28 with ESR and CRP as well as determining the treatment received by the patients. We analyzed the differences in responses to treatment in males and females using both indexes, as well as their component and the assessment of the disease by the physician.


Women had higher disease activity and disability at baseline. Although they received more intensive treatment, their average value of DAS28 remained significantly higher compared to men during the followup. By contrast, the global disease assessment evaluated by the patient and by the physician remained similar in both gender. When we analyze the DAS28 components separately, it was observed that this discrepancy was due mainly to the tender joints count and the ESR.


Women with early RA have higher DAS28ESR scores as a result of higher tender joint counts and ESR. This may represent bias when assessing the response to treatment using the DAS28ESR.

Rheumatoid artritis
Disease Activity Indices

Valorar las diferencias de respuesta al tratamiento mediante DAS28 calculado mediante velocidad de sedimentación globular (VSG) y proteína C reactiva teniendo en cuenta el género del paciente y analizar el comportamiento individual de cada uno de sus componentes en una cohorte de pacientes de artritis precoz en el área 2 de la Comunidad de Madrid.

Pacientes y métodos

Se estudiaron un total de 134 pacientes (77,6% mujeres) que cumplían criterios del Colegio Americano de Reumatología para el diagnóstico de artritis reumatoide del registro de artritis precoz del Hospital de La Princesa. En dicho registro se realizaron 4 visitas protocolizadas en las que se recogen de forma sistemática los datos necesarios para calcular el DAS28 con VSG y proteína C reactiva, así como el tratamiento prescrito a los pacientes. Se analizaron las diferencias por género en la respuesta al tratamiento mediante ambos índices compuestos, así como de las variables que los componen y la valoración de la enfermedad por el médico.


Las mujeres presentaron mayor actividad de la enfermedad y discapacidad al inicio del seguimiento. A pesar de que éstas recibieron un tratamiento más intenso, su valor promedio de DAS28 no llegó a igualarse con el de los hombres a lo largo del seguimiento. Por el contrario, la valoración de la enfermedad por parte del paciente y del médico sí llegó a igualarse. Al analizar los componentes del DAS28 por separado, se observó que esta discordancia era debida principalmente a las variables VSG y recuento de articulaciones dolorosas.


La VSG y el recuento de articulaciones dolorosas causan un sesgo en la evaluación de la actividad de la artritis reumatoide con el DAS28 que puede afectar a la evaluación de la respuesta al tratamiento.

Palabras clave:
Artritis reumatoide
Índices de actividad
Velocidad de sedimentación globular
Proteína C reactiva
Full text is only aviable in PDF
I. González-Álvaro, M.A. Descalzo, L. Carmona.
Trends towards an improved disease state in rheumatoid arthritis over time: influence of new therapies and changes in management approach: analysis of the EMECAR cohort.
Arthritis Res Ther, 10 (2008), pp. R138
C. Grigor, H. Capell, A. Stirling, A.D. McMahon, P. Lock, R. Vallance, et al.
Effect of a treatment strategy of tight control for rheumatoid arthritis (the TICORA study): a single-blind randomised controlled trial.
M.L. Prevoo, M.A. Van ‘t Hof, H.H. Kuper, M.A. Van Leeuwen, L.B. Van de Putte, P.L. Van Riel.
Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis.
Arthritis Rheum, 38 (1995), pp. 44-48
K. Forslind, I. Hafstrom, M. Ahlmen, B. Svensson.
Sex: a major predictor of remission in early rheumatoid arthritis?.
Ann Rheum Dis, 66 (2007), pp. 46-52
A. Miller, M. Green, D. Robinson.
Simple rule for calculating normal erythrocyte sedimentation rate.
Br Med J (Clin Res Ed), 286 (1983), pp. 266
D.T. Felson, J.J. Anderson, M. Boers, C. Bombardier, D. Furst, C. Goldsmith, et al.
American College of Rheumatology. Preliminary definition of improvement in rheumatoid arthritis.
Arthritis Rheum, 38 (1995), pp. 727-735
E. Inoue, H. Yamanaka, M. Hara, T. Tomatsu, N. Kamatani.
Comparison of Disease Activity Score (DAS)28–erythrocyte sedimentation rate and DAS28-C-reactive protein threshold values.
Ann Rheum Dis, 66 (2007), pp. 407-409
T. Matsui, Y. Kuga, A. Kaneko, J. Nishino, Y. Eto, N. Chiba, et al.
Disease Activity Score 28 (DAS28) using C-reactive protein underestimates disease activity and overestimates EULAR response criteria compared with DAS28 using erythrocyte sedimentation rate in a large observational cohort of rheumatoid arthritis patients in Japan.
Ann Rheum Dis, 66 (2007), pp. 1221-1226
I. Castrejón, A.M. Ortiz, R. García-Vicuna, J.P. Lopez-Bote, A. Humbria, L. Carmona, et al.
Are the C-reactive protein values and erythrocyte sedimentation rate equivalent when estimating the 28-joint disease activity score in rheumatoid arthritis?.
Clin Exp Rheumatol, 26 (2008), pp. 769-775
F.C. Arnett, S.M. Edworthy, D.A. Bloch, D.J. McShane, J.F. Fries, N.S. Cooper, et al.
The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis.
Arthritis Rheum, 31 (1988), pp. 315-324
E. Hallert, I. Thyberg, U. Hass, E. Skargren, T. Skogh.
Comparison between women and men with recent onset rheumatoid arthritis of disease activity and functional ability over two years (the TIRA project).
Ann Rheum Dis, 62 (2003), pp. 667-670
B.F. Leeb, P.M. Haindl, A. Maktari, T. Nothnagl, B. Rintelen.
Disease activity score-28 values differ considerably depending on patient's pain perception and sex.
J Rheumatol, 34 (2007), pp. 2382-2387
A.M. Unruh.
Gender variations in clinical pain experience.
Pain, 65 (1996), pp. 123-167
J.S. Feine, M.C. Bushnell, D. Miron, G.H. Duncan.
Sex differences in the perception of noxious heat stimuli.
Pain, 44 (1991), pp. 255-262
S. Lautenbacher, G.B. Rollman.
Sex differences in responsiveness to painful and nonpainful stimuli are dependent upon the stimulation method.
Pain, 53 (1993), pp. 255-264
R.W. Gear, N.C. Gordon, P.H. Heller, S. Paul, C. Miaskowski, J.D. Levine.
Gender difference in analgesic response to the kappa-opioid pentazocine.
Neurosci Lett, 205 (1996), pp. 207-209
F. Wolfe, T. Pincus, A.K. Thompson, J. Doyle.
The assessment of rheumatoid arthritis and the acceptability of self-report questionnaires in clinical practice.
Arthritis Rheum, 49 (2003), pp. 59-63
M. Ahlmén, B. Svensson, K. Albertsson, K. Forslind, I. Hafström, BARFOT Study Group.
Influence of gender on assessments of disease activity and function in early rheumatoid arthritis in relation to radiographic joint damage.
Ann Rheum Dis., 69 (2001), pp. 230-233
D. Aletaha, R. Landewe, T. Karonitsch, J. Bathon, M. Boers, C. Bombardier, et al.
Reporting disease activity in clinical trials of patients with rheumatoid arthritis: EULAR/ACR collaborative recommendations.
Arthritis Rheum, 59 (2008), pp. 1371-1377
M.L. Prevoo, A.M. Van Gestel, T.H.M.A. Van, M.H. Van Rijswijk, L.B. Van de Putte, P.L. Van Riel.
Remission in a prospective study of patients with rheumatoid arthritis. American Rheumatism Association preliminary remission criteria in relation to the disease activity score.
Br J Rheumatol, 35 (1996), pp. 1101-1105
P. Emery, R. Van Vollenhoven, M. Ostergaard, E. Choy, B. Combe, W. Graninger, et al.
Guidelines for initiation of anti-tumour necrosis factor therapy in rheumatoid arthritis: similarities and differences across Europe.
Ann Rheum Dis, 68 (2009), pp. 456-459
D. Aletaha, J. Smolen.
The Simplified Disease Activity Index (SDAI) and the Clinical Disease Activity Index (CDAI): a review of their usefulness and validity in rheumatoid arthritis.
Clin Exp Rheumatol, 23 (2005), pp. S100-S108
J.S. Smolen, F.C. Breedveld, M.H. Schiff, J.R. Kalden, P. Emery, G. Eberl, et al.
A simplified disease activity index for rheumatoid arthritis for use in clinical practice.
Rheumatology (Oxford), 42 (2003), pp. 244-257
Copyright © 2010. Sociedad Española de Reumatología and Colegio Mexicano de Reumatología
Reumatología Clínica (English Edition)

Subscribe to our newsletter

Article options
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?