Should We Manage Men & Women Differently?

If men and women with PsA are so different, should our treatment strategies differ as well? Dr. Coates said, “I personally don’t have different targets for my patients, but I think this is something we should be aware of. Women seem to accept worse targets as an ‘acceptable symptom state’.”⁷

Dr. Eder

Treatment Response

Lihi Eder, MD, PhD, associate professor of medicine, University of Toronto, Ontario, Canada, continued the session with more data and insight into how sex differences affect treatment response in PsA.

 “Our approach to treatment is currently gender blinded,” said Dr. Eder. “We assume that what works for men automatically works for women, and this [belief] may not be true. We should be thinking about moving toward a more gender-specific approach.”

Example: Most drugs recommend the same dose for men and women. Zolpidem, a sedative-hypnotic, is one of few drugs that has a different FDA-approved dose for men and women due to safety concerns. But overall, Dr. Eder noted that “sex-specific dosing remains unusual.”

When you examine differences in efficacy across biologics with different mechanisms of action in PsA, results are striking. Dr. Eder said, “For all biologic therapies, all of them show preferential response in male patients compared with female patients, except for the Janus kinase (JAK) inhibitors and tyrosine kinase 2 (TYK2) inhibitors. Is there something different about these?”⁸

Men and women also discontinue drugs for different reasons, and Dr. Eder noted that “most of the studies looking at persistence [i.e., the time from initiation to discontinuation of therapy] aren’t looking at the reasons for discontinuation.”

Research from Dr. Eder and colleagues shows that most women discontinue therapy because their joints aren’t doing well, or they’re experiencing medication side effects. On the other hand, men will more often discontinue treatments because of concern about potential adverse effects, improvement in symptoms or a dislike of taking medications.⁹

Experience of Pain

So what causes these differences?

Men and women experience pain differently. Pain mechanisms differ qualitatively between men and women, and sex hormones also affect pain processing.¹⁰ Dr. Eder said, “It has been shown in multiple musculoskeletal conditions that female patients tend to report higher scores of pain, as well as lower thresholds for pain. And there are differences in the patterns of pain. Women are more likely to report more diffuse pain, which we may call fibromyalgia. We need to be aware of this [difference] and not automatically consider fibromyalgia in this situation. It may reflect true inflammatory pain.”¹¹