Ann Rheum Dis 71:1203-1206 doi:10.1136/annrheumdis-2011-200947
  • Clinical and epidemiological research
  • Concise report

Is there a sex bias in prescribing anti-tumour necrosis factor medications to patients with rheumatoid arthritis? A nation-wide cross-sectional study

  1. Ronald F van Vollenhoven3
  1. 1Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
  2. 2Faculty of Medicine, University of Iceland, Reykjavik, Iceland
  3. 3Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Karolinska Institutet, Stockholm, Sweden
  1. Correspondence to Elizabeth V Arkema, Karolinska Institutet, Clinical Epidemiology Unit, Department of Medicine, Stockholm 17176, Sweden; earkema{at}
  1. Contributors JKJ and RFvV formed the hypothesis, and EVA, MN and JS performed the analysis. EVA, MN, JS and RFvV interpreted the results. EVA, JJ and RV drafted the paper. All authors contributed to editing the draft for content and approved the final version of the paper. All authors, external and internal, had full access to all the data (including statistical reports and tables) in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

  • Accepted 26 February 2012
  • Published Online First 13 April 2012


Objectives To determine whether men and women with rheumatoid arthritis are prescribed anti-tumour necrosis factor (anti-TNF) treatment at different levels of disease activity.

Methods Data from the Swedish national biologics registry ARTIS were used to analyse characteristics of patients' disease at the start of the first anti-TNF treatment. Means for men and women were compared using t-tests, and non-normally distributed covariates were compared using the Wilcoxon rank-sum test. Linear regression models, adjusted for age and calendar year, were used to investigate the association between sex and each disease activity measurement.

Results Women were younger and had longer disease duration at treatment start than men. Tender joint count, erythrocyte sedimentation rate, patient's global assessment, patient-reported pain and health assessment questionnaire scores were significantly higher in women, whereas men had a higher level of C-reactive protein (p<0.05 for all comparisons). Swollen joint count and physician's global assessment did not differ by sex.

Conclusions For women with rheumatoid arthritis, treatment with anti-TNF therapy was initiated at a higher level of subjective disease activity than for men, but at the same level of physician-reported disease activity. These data imply that patients' subjectively experienced disease activity may be discounted in the treatment decision.


  • Ethics approval The study was approved by the ethics committee of Karolinska Institutet.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.