One’s gender has a well-recognized impact on the prevalence and, to a lesser extent, disease course and treatment outcome in patients with RA. Women are more likely to develop RA and have more severe disease than men, and men often have a greater treatment response, as demonstrated in nearly every well-powered, well-designed clinical trial, including the Treatment of Early Aggressive Rheumatoid Arthritis (TEAR) trial (NCT00259610) and the Rheumatoid Arthritis: Comparison of Active Therapies in Patients With Active Disease Despite Methotrexate Therapy (RACAT) trial (NCT00405275). However, despite these differences, both men and women with RA experience improvements in disease activity when they receive appropriate treatment, and there is not a differential response across therapies. In other words, I will use the same drugs in a given clinical scenario, regardless of the patient’s sex. While I know that “X” percent of men will respond to a particular medication and that a slightly lower percentage of women will respond to that same medication, it will not change my treatment of these patients. This allows me to reassure my patients about their prospects for a favorable outcome with treatment. It is unusual for a patient to not do well, regardless of sex, if he or she adheres to his or her medication regimen.

Nevertheless, there are some considerations regarding age and gender. For example, I would be much less concerned with a 65-year-old man taking corticosteroids than I would for a 65-year-old woman because the risk of osteoporosis is more distant for the man than it is for the woman. There are also some gender differences with respect to disease processes, such as significantly more lung disease in men, but we do not yet know how differences in parameters could translate into the selection of therapies for various patient groups. Thus, the treatment of RA, to a large degree, remains an art form. While guidelines can be useful in the management of RA, the role of clinical judgment remains significant because there are not studies that directly apply to every clinical situation. Protocolized-driven therapy is good, to a point, but it breaks down faster in RA than in other disease states. You have to weigh the pros and cons of a particular therapy for each individual situation, but I have never seen a patient with RA whom I could not help.