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Vol. 6. Issue 3.
Pages 134-140 (May - June 2010)
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Vol. 6. Issue 3.
Pages 134-140 (May - June 2010)
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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
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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
Abstract
Objective

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.

Results

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.

Conclusions

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.

Keywords:
Rheumatoid artritis
Gender
Disease Activity Indices
DAS28
ESR
CRP
Resumen
Objetivo

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.

Resultados

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.

Conclusiones

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
Género
Índices de actividad
DAS28
Velocidad de sedimentación globular
Proteína C reactiva
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Copyright © 2010. Sociedad Española de Reumatología and Colegio Mexicano de Reumatología
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